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Insurance Utilization Reviewer Jobs in Phoenix, AZ

ADP - RNOOID0027504373

Licensed Therapist

Tempe, AZ · On-site

$55K - $70K/yr

... billing department for utilization review. Essential Functions and Duties Include: Duties ... Health insurance * Life insurance * Paid time off * Vision insurance Schedule: * 8 hour shift ...

Honorhealth

RN Case Manager Deer Valley

Phoenix, AZ · On-site

... insurance company guidelines. Advocates for patients/families and liaisons with key team member to ... utilization review documents according to hospital policy and state/ federal regulations.

HonorHealth

RN Case Manager Deer Valley

Phoenix, AZ · On-site

... insurance company guidelines. Advocates for patients/families and liaisons with key team member to ... utilization review documents according to hospital policy and state/ federal regulations.

Acadia Healthcare

Business Office Manager

Chandler, AZ · On-site

... Utilization Review and Admissions staff to ensure proper authorization of patient insurance coverage. • May include managing and directing subordinate staff to identify goals and objectives.

HonorHealth

RN Case Manager Osborn

Scottsdale, AZ · On-site

... insurance company guidelines. Advocates for patients/families and liaisons with key team member to ... utilization review documents according to hospital policy and state/ federal regulations.

Banner Health

Chief Health Services Officer

Phoenix, AZ · On-site

... Utilization Review, Concurrent Review and Transplant Coordination) in conjunction with Medical ... Insurance Division products, partners, and organization in the best possible light; developing ...

Rite of Passage

Collections Specialist

Queen Creek, AZ · On-site

$18.50 - $25/hr

Communicate with insurance representatives regarding claim status, authorization issues, and payment resolution * Collaborate with admissions, utilization review, credentialing, and billing teams to ...

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All JobsInsurance Utilization Reviewer JobsInsurance Utilization Reviewer Jobs in Phoenix, AZ

Insurance Utilization Reviewer information

See Phoenix, AZ salary details

$30.8K

$37.7K

$43.7K

How much do insurance utilization reviewer jobs pay per year?

As of Sep 6, 2026, the average yearly pay for insurance utilization reviewer in Phoenix, AZ is $37,723.00, according to ZipRecruiter salary data. Most workers in this role earn between $33,800.00 and $41,700.00 per year, depending on experience, location, and employer.

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.

What are popular job titles related to Insurance Utilization Reviewer jobs in Phoenix, AZ?

For Insurance Utilization Reviewer jobs in Phoenix, AZ, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Reviewer jobs in Phoenix, AZ look for?

The top searched job categories for Insurance Utilization Reviewer jobs in Phoenix, AZ are:

Insurance Utilization Reviewer jobs near you

Licensed Therapist

ADP - RNOOID0027504373

Tempe, AZ • On-site

$55K - $70K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 6 hours ago

Job description

Job description

Job Summary:

Providing group therapy sessions to clients with primary substance use disorders and secondary mental health disorders. Clinicians will perform group, individual, and family sessions with clients. Clinicians work closely with other clinicians, BHT’s, and case managers, and clinical administration for Recovery Syndicate. The IOP clinician will complete all documentation in EMR in a timely fashion within 24 hours and work with the billing department for utilization review.

Essential Functions and Duties Include:

Duties/Responsibilities:

  • Provide high-quality, compassionate, and ethical substance abuse therapy to clients as scheduled in the group, individual, and family therapy sessions.
  • Complete all required documentation as necessary including, treatment plans, group notes, individual session notes, and discharge summaries.
  • Complete accurate clinical documentation on the same day of service.
  • Stay current with updates on clinical research and best practices.
  • Participate in weekly clinical supervision.
  • Secure client information per HIPAA standards.
  • Complete all recommended continuing education requirements for licensure.
  • This list is not all inclusive or exhaustive

Education, Qualifications, & Credentials:

Master's degree in Addiction Sciences or counseling from an accredited university.

Experience working in behavioral health or addiction counseling and facilitating IOP groups.

License at any level to provide counseling in the state of Arizona, i.e. LSAT, LASAC, or LISAC Or LAC or LPC, and LMSW or LCSW.

Clinical supervision is available for licensure

Job Types: Full Time

Ability to commute/relocate:

  • Chandler, AZ 85225: Reliably commute or planning to relocate before starting work (Required)

Experience:

  • Therapists & Counselors: 1 year (Preferred)

Job Types: Full-time, Part-time

Salary: $55,000.00 - $70,000.00 per year

Benefits:

  • 401(k)
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Schedule:

  • 8 hour shift

Ability to commute/relocate:

  • Tempe, AZ 85284: Reliably commute or planning to relocate before starting work (Required)

Education:

  • Master's (Required)

Experience:

  • Case management: 1 year (Preferred)
  • Motivational interviewing: 1 year (Preferred)
  • Mental health counseling: 1 year (Required)

License/Certification:

  • License through AZBHE (Required)

Work Location: One location