ZipRecruiter

Log In

1

Insurance Utilization Reviewer Jobs (NOW HIRING)

RHI Rehab

Utilization Reviewer (FT)

Indianapolis, IN · On-site

The Utilization Reviewer contributes to assessment and planning by performing a thorough review of ... Documents all insurance information appropriately on forms and in computer system as applicable.

next page

Showing results 1-20

All JobsInsurance Utilization Reviewer Jobs

Insurance Utilization Reviewer information

See salary details

$31K

$38K

$44K

How much do insurance utilization reviewer jobs pay per year?

As of Jul 13, 2026, the average yearly pay for insurance utilization reviewer in the United States is $37,992.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,000.00 and $42,000.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an Insurance Utilization Reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are some common challenges faced by Insurance Utilization Reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What are Insurance Utilization Reviewers?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.
More about Insurance Utilization Reviewer jobs
What cities are hiring for Insurance Utilization Reviewer jobs? Cities with the most Insurance Utilization Reviewer job openings:
What states have the most Insurance Utilization Reviewer jobs? States with the most job openings for Insurance Utilization Reviewer jobs include:
What job categories do people searching Insurance Utilization Reviewer jobs look for? The top searched job categories for Insurance Utilization Reviewer jobs are:
Insurance Utilization Reviewer jobs near you

Utilization Reviewer (FT)

RHI Rehab

Indianapolis, IN • On-site

Other

Retirement

Posted 10 days ago

Job description

The Rehabilitation Hospital of Indiana (RHI) is nationally ranked among the Best Hospitals for Rehabilitation by U.S. News and World Report for 2025-2026 and the Best Rehabilitation Hospital in Indiana for the third year in a row. RHI provides high quality, evidence-based rehabilitation services to those facing life-changing injuries or illness. RHI is the only Traumatic Brain Injury (TBI) Model System in the state of Indiana and one of only 16 in the U.S We offer a competitive compensation and benefits package, along with a 401k match and tuition reimbursement program.
Summary:
The Utilization Reviewer contributes to assessment and planning by performing a thorough review of the total resources available to patient pre and post-discharge from rehabilitation care. The Utilization Reviewer collaborates with the payer and rehabilitation team to ensure a successful transition to the discharge setting and or goal achievement, and durability of outcome.
Essential Functions
  • Assesses all of patient's payer sources for rehabilitation course, determines resources available for patient, and ensures maximal use of available health coverage resources for each patient.
  • Completes pre-certification and prior authorization timely for admission and or services.
  • Documents all insurance information appropriately on forms and in computer system as applicable.
  • Functions as liaison with payer representatives to manage the rehabilitation process in keeping with the patient's financial resources, including verification of benefits for this and future settings.
  • Completes retro authorizations as applicable and ensures follow through relative to authorizations for all services through the complete revenue cycle.
  • Other duties as assigned.
Education and Experience
  • Greater than 2 years of UR experience with a strong clinical background and competence with a rehabilitation population.
  • Bachelor's degree in related field with 3-5 years' experience
  • LPN or RN experience preferred
Hours
  • Monday - Friday (8:30am-5:00pm)
  • This position is on-site at RHI

The Rehabilitation Hospital of Indiana is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, or any other characteristic protected by law.

Apply