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Insurance Utilization Reviewer Jobs in Minnesota

Adecco Healthcare & Life Sciences is partnering with our client to hire an experienced Utilization ... Experience reviewing medical necessity determinations or insurance denials * Experience ...

Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time ...

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Insurance Utilization Reviewer information

What is an insurance utilization reviewer?

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.

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 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 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.

Infographic showing various Insurance Utilization Reviewer job openings in Minnesota as of July 2026, with employment types broken down into 100% Full Time. Highlights an 89% In-person, and 11% Remote job distribution.

Utilization Management Coordinator

Golden Valley, MN • On-site

Allina Health
Health Care and Social Assistance • 10K+ employees

$18.49 - $25.19/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New


Allina Health rating

8.0

Company rating: 8.0 out of 10

Based on 284 frontline employees who took The Breakroom Quiz


Job description

Location Address:

3915 Golden Valley Rd Minneapolis, MN 55422-4249

Date Posted:

September 11, 2026

Department:

16000604 CKRI/Rehab Admin

Shift:

Day (United States of America)

Shift Length:

8 hour shift

Hours Per Week:

40

Union Contract:

Non-Union-NCT

Weekend Rotation:

None

Job Summary:

Allina Health is a not-for-profit health system that cares for individuals, families and communities throughout Minnesota and western Wisconsin. If you value putting patients first, consider a career at Allina Health. Our mission is to provide exceptional care as we prevent illness, restore health and provide comfort to all who entrust us with their care. This includes you and your loved ones. We are committed to providing whole person care, investing in your well-being, and enriching your career.

Key Position Details:

This position will work within the Admissions office. Primary duties include data entry, phone communication with referral sources and family members, and meeting with patients and their families to complete the admission process.

  • 1.0 FTE (80 hours per two-week pay period)
  • 8-hour day shift
  • No weekends

Job Description:

Responsible for completing operational functions within Utilization Management. Provides Utilization Management support services that are critical to support the accurate and timely utilization review of patients at Allina Health.
Principle Responsibilities

  • Provides administrative support for utilization management processes.
  • Triages and manages payer correspondence via phone, fax, or mail.
    • Divides incoming work (faxes, phone-correspondence, mail) by priority level (prioritization) so that the highest priorities are handled first (time sensitive).
  • Refers cases to the utilization management specialist.
    • High-level of coordination is required to ensure specific payer requirements are met; must be able to quickly review information from multiple sources and direct questions and concerns to the appropriate staff person for resolution; must provide timely feedback to payers that requires research and coordination of information from various areas including UM specialists.
    • Clarifies administrative requirements for patients with uncommon payers; receives timely feedback from multiple sources; maintains strong systems that ensure timely follow-up without losing focus on attention to details; keeps up with high volume of requests for information from multiple sources.
  • Assists the UM Specialists in obtaining authorizations and certifications based on payer requirements.
    • Concurrent review follow-up and data retrieval for payer requirements to support review process for UMS.
  • Facilitates concurrent claim denial process.
  • Other duties as assigned.


Required Qualifications

  • Must be 18 years of age with education and/or experience needed to meet required functional competencies as listed on the job description
  • 0 to 2 years of business office experience


Preferred Qualifications

  • High school diploma or GED
  • Associate's or Vocational degree in business, healthcare, or related field preferred
  • 2+ years of experience working healthcare business office
  • 2+ years of experience working in insurance operations
  • 2+ years of experience working in Epic
  • 2+ years of experience working in Microsoft Office
  • 2+ years of experience working with revenue cycle and billing


Physical Demands

  • Sedentary:
  • Lifting weight up to 10 lbs. occasionally, negligible weight frequently

Pay Range

Pay Range: $18.49 to $25.19 per hourThe pay described reflects the base hiring pay range. Your starting rate would depend on a variety of factors including, but not limited to, your experience, education, and the union agreement (if applicable). Shift, weekend and/or other differentials may be available to increase your pay rate for certain shifts or work.

Allina Health is committed to adhering with all applicable local, state and federal minimum wage requirements.

Benefit Summary


Allina Health believes the best way to provide safe and compassionate care for our patients is by nurturing the passion of those who care for them. That's why we devote extraordinary resources to help you grow and thrive - not only as a professional but also as a whole person. When you join our team, you have access to a wealth of valuable employee benefits that support the total well-being - mind, body, spirit and community - of you and your family members.


Allina Health is all in on your well-being. Because well-being means something different to everyone, our award-winning program provides you with the resources you need to help you navigate your personal journey. This includes well-being dollars, dedicated well-being navigators, and many programs, activities, articles, videos, personal coaching and tools to support you on your journey.


We are focused on creating an inclusive workplace so everyone can see themselves as part of our care team. Our care teams are as diverse as the communities we serve and proud to be contributing to the mission of a leading health care organization. Our pioneering approach to well-being helps every member of our care team feel a deep sense of connection and joy in their work.


Benefits include:

  • Medical/Dental
  • PTO/Time Away
  • Retirement Savings Plans
  • Life Insurance
  • Short-term/Long-term Disability
  • Voluntary Benefits (vision, legal, critical illness)
  • Tuition Reimbursement or Continuing Medical Education as applicable
  • Student Loan Support Benefits to navigate the Federal Public Service Loan Forgiveness Program
  • Allina Health is a 501(c)(3) eligible employer

*Benefit eligibility/offerings are determined by FTE and if you are represented by a union.


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