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Medical Utilization Review Jobs in Alabama (NOW HIRING)

Birmingham

Quality Review Coordinator

Birmingham, AL · On-site

ENVIRONMENT The Health Managed Department is responsible for developing, implementing and administering private business and government utilization review, medical review, cost containment ...

Birmingham

Quality Review Coordinator

Birmingham, AL · On-site

ENVIRONMENT The Health Managed Department is responsible for developing, implementing and administering private business and government utilization review, medical review, cost containment ...

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Medical Utilization Review information

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$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.

RN - Registered Nurse - Utilization Review - PRN Days

UAB St. Vincent's

Birmingham, AL • On-site

Per diem

Medical, PTO

Re-posted yesterday

Job description

  • Department: Utilization Review
  • Schedule: PRN Days
  • Work Location: UAB ST Vincent's Birmingham
  • Benefits for eligible positions only include: generous paid time off, paid parental leave, Associate Assistance Program, Tuition Reimbursement Program, and more 

Provide health care services regarding admissions, case management, discharge planning and utilization review.

  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.

Licensure / Certification / Registration:

  • Licensed Associate Professional Registered Nurse credentialed from the Alabama Board of Nursing
    obtained prior to hire date or job transfer date required.

Education:

  • Diploma from an accredited school/college of nursing and required professional licensure at time of hire.
  • One Year of Experience is required

No additional preferences.


UAB St. Vincent’s, a proud part of UAB Medicine, is a trusted provider of health care, serving Alabama for more than 125 years. With five hospitals and numerous clinics, we're a health care community deeply rooted in compassion, service, and respect for all, guided by the rich legacy of the St. Vincent’s name. We're committed to extending kindness and personalized care to patients, their families, and each other. We address the physical, psychological, social, and spiritual needs of our patients. We believe in the power of teamwork and unity, and foster a collaborative spirit among our more than 4,800 employees. As one of Alabama’s best hospitals as recognized by U.S. News & World Report, improving the health and lives of those we serve is at the heart of our mission. Join us in continuing our legacy of service and healing in central Alabama, where we can make a lasting impact together.

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