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Medical Utilization Review Physician Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Evaluate medical necessity, level of care, and documentation accuracy * Ensure compliance with ... Collaborate with physicians, case management, and care teams * Support discharge planning and care ...

TUBA CITY REGIONAL

Utilization Review

Tuba City, AZ · On-site

RN - Utilization Review Excel is seeking highly skilled healthcare professionals for travel ... Maintain accurate patient medical records and documentation. * Adhere to infection control ...

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How much do medical utilization review physician jobs pay per year?

As of Aug 11, 2026, the average yearly pay for medical utilization review physician in the United States is $233,521.00, according to ZipRecruiter salary data. Most workers in this role earn between $220,000.00 and $261,000.00 per year, depending on experience, location, and employer.

What is a medical utilization review physician?

A Medical Utilization Review Physician evaluates medical treatments, procedures, and hospital stays to ensure they are necessary, appropriate, and cost-effective. They review patient records, apply clinical guidelines, and collaborate with healthcare providers and insurance companies. Their role helps control healthcare costs while ensuring patients receive proper care. These physicians typically work for insurance companies, hospitals, or government agencies.

What are the key skills and qualifications needed to thrive as a medical utilization review physician?

To thrive as a Medical Utilization Review Physician, you need a valid medical degree (MD or DO), active state medical license, and strong clinical evaluation and decision-making skills. Familiarity with medical review guidelines, healthcare coding systems (like ICD-10 and CPT), and electronic health record (EHR) platforms is usually required. Excellent written and verbal communication, critical thinking, and attention to detail are vital soft skills for this position. These abilities ensure accurate case assessments, effective collaboration with healthcare teams, and compliance with regulatory standards.

What are the typical daily responsibilities of a medical utilization review physician?

Medical Utilization Review Physicians are primarily responsible for reviewing medical records to determine the appropriateness of healthcare services and ensure they meet established guidelines and medical necessity criteria. On a typical day, you may evaluate case files, document your findings, consult with treating physicians, and communicate with case managers or insurance representatives. The role often involves collaborating with multidisciplinary teams while balancing clinical judgment with regulatory and organizational requirements. This process helps ensure patients receive evidence-based care while also supporting efficient resource use within healthcare systems.

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What cities are hiring for Medical Utilization Review Physician jobs? Cities with the most Medical Utilization Review Physician job openings:
What are the most commonly searched types of Medical Utilization Review Physician jobs? The most popular types of Medical Utilization Review Physician jobs are:
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What job categories do people searching Medical Utilization Review Physician jobs look for? The top searched job categories for Medical Utilization Review Physician jobs are:
Medical Utilization Review Physician jobs near you
Infographic showing various Medical Utilization Review Physician job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $233,521 per year, or $112.3 per hour.

Utilization Review Physician

Vivo HealthStaff

Carteret, NJ • On-site

Full-time

Re-posted 15 days ago

Job description

Vivo HealthStaff is recruiting for a Utilization Review Physician based in New York for a Managed Care Insurance Plan. This position requires 4 days per month on-site.
The Utilization Review Physician is the lead clinician for the health plan. Responsible for the administration of medical services for company health plan utilizing the evidence-based medical policies and clinical guidelines of the plan, to ensure the appropriate and most cost-effective medical care is accessible and delivered to our members. Drives direction of the plan related to cost of care, clinical initiatives and population health management and outcomes.
Will function as the clinical lead, working alongside state plan president as the team interfaces with state regulators, providers and market facilities.
Requirements:
  • Board Certification in a specialty certified by either the American Board of Medical Specialties or American Osteopathic Association
  • Unrestricted Medical License in the State of New York
  • Minimum of 10 years of clinical practice post residency
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About Vivo HealthStaff

Sourced by ZipRecruiter

Vivo HealthStaff provides permanent recruitment services for both clinical and administrative positions in the healthcare sector. Over the past 2 years, our clients have seen a 98% retention rate with Vivo HealthStaff placements.

Industry

Health care and social assistance

Company size

11 - 50 Employees

Headquarters location

Dublin, CA, US

Year founded

2016

Social media

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