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Medical Utilization Review Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Minimum of 1 year of experience working with clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare settings. * Proven experience ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Minimum of 1 year of experience working with clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare settings. * Proven experience ...

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Medical Utilization Review information

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How much do medical utilization review jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for medical utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

How do I get into a utilization review?

To become a medical utilization review specialist, typically a healthcare or insurance background is required, along with knowledge of medical coding and insurance policies. Many employers prefer candidates with a relevant license or certification, such as the Certified Professional in Healthcare Quality (CPHQ) or Certified Medical Reviewer (CMR). Gaining experience in healthcare administration, medical billing, or case management can also improve job prospects in this field.

What are the key skills and qualifications needed to thrive as a Medical Utilization Review Specialist, and why are they important?

To thrive as a Medical Utilization Review Specialist, you need a background in healthcare (often as an RN or LPN), strong analytical abilities, and in-depth knowledge of medical terminology and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as Certified Professional in Healthcare Quality (CPHQ) are commonly required. Excellent communication, critical thinking, and attention to detail are vital soft skills for effectively reviewing cases and collaborating with providers. These competencies ensure accurate, efficient decision-making that supports both patient care standards and cost-effective healthcare delivery.

What jobs pay 2000 a day?

In the field of Medical Utilization Review, highly experienced professionals such as senior reviewers, medical directors, or consultants can potentially earn around $2,000 per day, especially when working as independent contractors or in specialized consulting roles. These positions often require advanced certifications, extensive experience, and a strong understanding of healthcare policies and insurance processes.

What are some common challenges faced by professionals in Medical Utilization Review, and how can they be addressed?

Professionals in Medical Utilization Review often encounter challenges such as managing high caseloads, staying updated with changing healthcare regulations, and balancing the needs of patients with cost-containment measures. Effective time management and ongoing education in current medical guidelines can help address these issues. Additionally, strong communication skills are essential for collaborating with healthcare providers and insurance companies to ensure appropriate care decisions while maintaining compliance.

What jobs pay 10,000 a month without a degree?

Medical Utilization Review professionals can earn around $10,000 per month with experience and certification, often working in healthcare settings reviewing insurance claims and patient care. Other high-paying roles without a degree include sales managers, real estate brokers, and certain skilled trades like commercial pilots or tech sales, which rely on skills, experience, and certifications rather than formal degrees.

What jobs will no longer exist in 2030?

Medical Utilization Review roles are unlikely to disappear by 2030, but automation and AI tools may reduce the need for manual review tasks. Some administrative or repetitive healthcare jobs could be phased out as technology advances, requiring professionals to adapt by developing skills in data analysis and health informatics.

What is the difference between Medical Utilization Review vs Medical Claims Reviewer?

AspectMedical Utilization ReviewMedical Claims Reviewer
CredentialsCertifications like CCM, RHIA, or RHIT often preferredCertifications such as CPC or CCS beneficial
Work EnvironmentHealthcare facilities, insurance companies, or third-party review organizationsInsurance companies, healthcare payers, or claims processing centers
Primary FocusAssessing necessity and appropriateness of medical servicesReviewing and processing insurance claims for payment
Industry UsageCommonly used in healthcare and insurance sectorsPrimarily in insurance and healthcare billing sectors

Medical Utilization Review focuses on evaluating the necessity of medical services, while Medical Claims Review centers on processing insurance claims. Both roles require healthcare knowledge and certifications, but they serve different functions within the healthcare and insurance industries.

What is medical utilization review?

Medical utilization review is a process used by healthcare organizations and insurance companies to evaluate the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities. The goal is to ensure that patients receive necessary care while avoiding unnecessary or redundant treatments. Utilization review helps control healthcare costs and maintains quality standards by reviewing cases before, during, and after care is provided. The process typically involves nurses, physicians, and other healthcare professionals who assess clinical information to make recommendations or decisions about coverage.
More about Medical Utilization Review jobs
What cities are hiring for Medical Utilization Review jobs? Cities with the most Medical Utilization Review job openings:
What states have the most Medical Utilization Review jobs? States with the most job openings for Medical Utilization Review jobs include:
What job categories do people searching Medical Utilization Review jobs look for? The top searched job categories for Medical Utilization Review jobs are:
Medical Utilization Review jobs near you
Infographic showing various Medical Utilization Review job openings in the United States as of June 2026, with employment types broken down into 96% Full Time, and 4% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Assistant

Utilization Review Assistant

Medical Center Hospital

Odessa, TX • On-site

Part-time

Posted 23 days ago

Medical Center Health System rating

8.2

Company rating: 8.2 out of 10

Based on 30 frontline employees who took The Breakroom Quiz

57th of 870 rated healthcare providers

Job description

Position Summary:
Assists UM Department with utilization review processes, including the collection and analysis of various computer-based data related to Utilization Review, Care Coordination, and Commercial Insurance.
Qualifications:
A. Education:
Must have a high school diploma or equivalent.
B. Training and Experience:
Must have a minimum of one-year work experience in an acute care medical facility.
C. Job Knowledge:
Familiar with medical terminology, utilization review, community resource a plus. Basic computer skills required. Be able to communicate effectively verbally and in writing.
Unusual Physical Demands and Working Conditions:
Should be familiar with healthcare operations. Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred.
Ability to communicate effectively and professionally, both verbally and in writing.

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