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Insurance Utilization Reviewer Jobs in Georgetown, TX

UHS

UR COORDINATOR

Liberty Hill, TX

The Utilization Review Coordinator is responsible for bridging communications between the hospital treatment team and insurance company/referral agencies. Will analyze clinical documentation to ...

UHS

UR COORDINATOR - PRN

Liberty Hill, TX

The Utilization Review Coordinator is responsible for bridging communications between the hospital treatment team and insurance company/referral agencies. Will analyze clinical documentation to ...

UHS

UR COORDINATOR

Liberty Hill, TX

The Utilization Review Coordinator is responsible for bridging communications between the hospital treatment team and insurance company/referral agencies. Will analyze clinical documentation to ...

UHS

UR COORDINATOR - PRN

Liberty Hill, TX · On-site

The Utilization Review Coordinator is responsible for bridging communications between the hospital treatment team and insurance company/referral agencies. Will analyze clinical documentation to ...

UHS

UR COORDINATOR

Liberty Hill, TX · On-site

The Utilization Review Coordinator is responsible for bridging communications between the hospital treatment team and insurance company/referral agencies. Will analyze clinical documentation to ...

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All JobsInsurance Utilization Reviewer JobsInsurance Utilization Reviewer Jobs in Georgetown, TX

Insurance Utilization Reviewer information

See Georgetown, TX salary details

$28.8K

$35.3K

$40.9K

How much do insurance utilization reviewer jobs pay per year?

As of Jul 14, 2026, the average yearly pay for insurance utilization reviewer in Georgetown, TX is $35,299.00, according to ZipRecruiter salary data. Most workers in this role earn between $31,600.00 and $39,000.00 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.
What job categories do people searching Insurance Utilization Reviewer jobs in Georgetown, TX look for? The top searched job categories for Insurance Utilization Reviewer jobs in Georgetown, TX are:
What cities near Georgetown, TX are hiring for Insurance Utilization Reviewer jobs? Cities near Georgetown, TX with the most Insurance Utilization Reviewer job openings:
Insurance Utilization Reviewer jobs near you
Utilization Review Coordinator - PRN position

Utilization Review Coordinator - PRN position

Georgetown Behavioral Health Institute

Georgetown, TX • On-site

Full-time, Per diem

Medical, Dental, Vision, Retirement, PTO

Posted 24 days ago

Job description

Our inpatient behavioral health hospital is seeking a PRN Utilization Review Coordinator.

This position is responsible for working with insurance companies and managed care systems for the initial authorization, concurrent and retrospective review of inpatient, partial, and intensive outpatient admissions and services. Previous experience in utilization review or case management desirable.

This position will obtain authorization for each admitted patient. Review and monitor each step of the authorization process to proactively identify potential problems to help patients access the full range of their benefits through the utilization review process.

Requirements

Education and/or Licensure – Bachelor’s degree or equivalent in nursing preferred.

Experience – 3-5 years Admitting or Financial Counseling preferred. Prefer two years clinical experience in a facility with medical terminology and in criteria for acute psychiatric inpatient care. Knowledgeable of insurance coverage and billing practices preferred. Previous experience in utilization review or case management desirable.

Additional Requirements – Must possess or obtain a valid CPR certification and certified in facility approved verbal de-escalation and physical crisis management techniques within 30 days of hire and prior to completion of orientation required.

Benefits

Full-time employees are eligible for medical, dental, vision, company paid disability, 401(k) and a generous amount of paid time off.