ZipRecruiter

Log In

1

Medical Utilization Review Jobs in Alabama (NOW HIRING)

next page

Showing results 1-20

All JobsMedical Utilization Review JobsMedical Utilization Review Jobs in Alabama

Medical Utilization Review information

See Alabama salary details

$19

$38

$62

How much do medical utilization review jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for medical utilization review in Alabama is $38.32, according to ZipRecruiter salary data. Most workers in this role earn between $30.29 and $43.99 per hour, depending on experience, location, and employer.

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.

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 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 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.

How do I get into a medical utilization review?

To become a medical utilization review specialist, candidates typically need a healthcare background such as nursing, medical assisting, or health administration, along with knowledge of insurance policies and medical coding. Certification programs like the Certified Professional Medical Auditor (CPMA) or Certified Medical Reviewer (CMR) can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and billing systems.

Is medical utilization review a good job?

Medical utilization review is a healthcare role focused on evaluating the necessity and efficiency of medical services, often requiring knowledge of insurance policies and clinical guidelines. It offers opportunities for stable employment, typically involves administrative and analytical skills, and may require certification such as the Certified Professional Medical Auditor (CPMA). The job can provide a predictable schedule and work-from-home options, making it a viable career choice for those interested in healthcare administration.

What are popular job titles related to Medical Utilization Review jobs in Alabama?

For Medical Utilization Review jobs in Alabama, the most frequently searched job titles are:

What job categories do people searching Medical Utilization Review jobs in Alabama look for?

The top searched job categories for Medical Utilization Review jobs in Alabama are:

Medical Utilization Review jobs near you
Infographic showing various Medical Utilization Review job openings in Alabama as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 15% Part Time, and 8% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $79,714 per year, or $38.3 per hour.

Utilization Review Technician

Riverview Regional Medical Center

Gadsden, AL • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Job description

Overview
Department: Social Work Services
Shifts Available: Days
Employment Type: Full Time
Hours: 8-hour shift - 7:30am to 3:30pm
Location: Riverview Regional Medical Center - Gadsden, AL
We are seeking an Utilization Review Technician II, sometimes referred to as Utilization Management Technician II or Utilization Review Coordinator II. The Utilization Review Technician II supports the utilization review, appeals, and denial management process by coordinating communication and tracking payer-related activity. This role works closely with insurance providers, health plans, Utilization Review teams, the Business Office, and Case Managers to help ensure timely follow-up on authorizations, reviews, appeals, and denials. The position also assists with payer audits, Release of Information, discharge coordination, and other departmental needs.
Responsibilities
  • Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews, appeals, and denials
  • Document and track all communication attempts with insurance providers and health plans
  • Follow up on denials while partnering with Utilization Review, Business Office, and Case Management teams
  • Maintain accurate tracking of government and payer audits, including RAC, MAC, CERT, ADR, QIO, Medicaid, and pre/post-payment reviews
  • Provide support with Release of Information, discharge coordination, and other assigned departmental duties

Qualifications
  • High School Diploma or equivalent
  • Two years of relevant experience
  • Accurate alphabetic, numeric, and/or terminal-digit filing skills
  • Computer data entry with 10-key, with accurate typing speed of 35 wpm
  • Associates Degree or higher, preferred
  • Excel skills. highly preferred
  • Knowledge of terminal digit filing and medical terminology, preferred
  • Knowledge of State and Federal regulatory requirements for medical staff documentation, preferred
  • Completion of a medical terminology course, preferred
  • Background in business and office training, preferred

Here are some of the benefits of working at Prime Healthcare:
  • Health, dental, and vision insurance options
  • Paid vacation, sick time and holidays
  • Bereavement leave, FMLA and other leave options
  • Employer 401K options
  • Tuition reimbursement options
  • Life, disability, and other insurance options
  • Many other amazing benefits

Full benefits at Prime Healthcare: https://www.primehealthcare.com/careers/benefits/
#LI-MP1
Employment Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Apply