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Medical Utilization Review Jobs in Missouri (NOW HIRING)

Enlyte

Utilization Reviewer 2

Saint Louis, MO · On-site

$52K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective ... Evaluates medical documentation to ensure compliance with industry standards and regulatory ...

Enlyte

Utilization Reviewer 2

Saint Louis, MO · On-site

$52K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective ... Evaluates medical documentation to ensure compliance with industry standards and regulatory ...

Arch Vista

UR Coordinator

Saint Louis, MO · On-site

$15 - $22/hr

Familiarity with utilization management, medical necessity review, or case management workflows. * Experience working with electronic medical records and authorization tracking systems. Why You'll ...

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All JobsMedical Utilization Review JobsMedical Utilization Review Jobs in Missouri

Medical Utilization Review information

See Missouri salary details

$20

$39

$64

How much do medical utilization review jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for medical utilization review in Missouri is $39.66, according to ZipRecruiter salary data. Most workers in this role earn between $31.35 and $45.53 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 Missouri?

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

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

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

Medical Utilization Review jobs near you
Infographic showing various Medical Utilization Review job openings in Missouri as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 16% Part Time, and 7% Contract. Highlights an 88% Physical, 1% Hybrid, and 11% Remote job distribution, with an average salary of $82,494 per year, or $39.7 per hour.

Utilization Review Assistant

Mosaic Life Care

Saint Joseph, MO • On-site

Full-time

Medical, Vision

Posted 24 days ago

Mosaic Life Care rating

6.6

Company rating: 6.6 out of 10

Based on 63 frontline employees who took The Breakroom Quiz

572nd of 898 rated healthcare providers

Job description

The Utilization Review Assistant is responsible for the administrative components of Utilization Management that primarily focuses on supporting the medical review process.


Skills and Abilities

Essential Technical/Motor Skills

  • Hand/eye coordination: speaks clearly; good hearing, ability to use computers, printers and telephone equipment
  • Interpersonal skills
  • Ability to work as a member of a team and develop trusting relationships quickly
  • Excellent verbal and written communication skills including sensitivity to other cultures and ethnicities.

Interpersonal Skills


    Essential Physical Requirements


      Essential Mental Abilities

      • Implements and provides ongoing support of members care plan, recognizes alternatives, identifying problems.
      • Provides patient and family teaching about health related needs, financial needs and other coping issues.
      • Concentrates on plans and roles of other team members, understanding all responsibilities and plans.

      Essential Sensory Requirements

      • Visual and hearing skills to obtain a driver's license are required.
      • Ability to communicate with members and families, communicating in person and on phone.

      Exposure to Hazards


        Other Skills and Abilities

        • Must have access to transportation
        • Responsible for communication of required healthcare documents to patients and/or representatives.
        • Adhere to regulatory and compliance standards
        • Understanding benefits including Medicaid and Medicare
        • Work closely with utilization review staff, care managers and social workers to assist with any administrative responsibilities or needs.
        • Documentation entry
        • Phone and Voicemail retrieval
        • Mail distribution within the department
        • Worklist management
        • Other duties assigned

        Education
        • H.S. Diploma - or GED - Required

        Work Experience
        • Experience in healthcare, managed care, hospital, or clinical setting, or other comparable work experience. - Preferred

        Licenses and Certifications
        • Upon Hire

        Travel Requirements
        • Travel to off-site locations may be required. - Required

        What Mosaic Life Care employees say

        Pay

        Benefits

        Hours and flexibility

        Workplace

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