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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 ...

Orison

RN - Utilization Review

Elmhurst, NY · On-site

Escalate cases to the appropriate physician advisor or Medical Director when criteria are not met ... Non-acute utilization review. Skills: RN,REGISTERED NURSE

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

This role is responsible for reviewing medical records, evaluating the medical necessity of ... Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare ...

Houston Healthcare

$80 - $100/hr

The Utilization Reviewer serves as a resource to medical and hospital staff on utilization and ... the physician and nursing staff with the best possible options for post hospital care for the ...

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

As of Sep 8, 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 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.

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.

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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 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $233,521 per year, or $112.3 per hour.

Utilization Review Specialist

Medical Center Hospital

Odessa, TX • On-site

Full-time

Re-posted 25 days ago

Medical Center Health System rating

8.4

Company rating: 8.4 out of 10

Based on 34 frontline employees who took The Breakroom Quiz

22nd of 898 rated healthcare providers

Job description

Position Summary:

The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors.

Qualifications:

A. Education:

Holds a current Texas license as a Registered Nurse OR a current Texas Licensed Vocational Nurse.

B. Training and Experience:

Three years of clinical nursing experience in a general medical/surgical setting or appropriate specialty area; at least one year in an acute care setting.

C. Job Knowledge:

Excellent verbal and written skills, well-rounded critical thinking skills, self-motivated, flexible, and goal-oriented. Ability to tolerate frequent interruptions and demanding workload.

VI. Unusual Physical Demands and Working Conditions:

Must be able to work long hours on occasion. Potential for some stress in meeting deadlines.

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