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Medical Utilization Review Jobs in Nebraska (NOW HIRING)

Nebraska Medicine

Dermatology-2026-216

Omaha, NE · On-site

$18 - $21.75/hr

Physician will participate in quality assurance, utilization review, and continuous quality improvement activities of The Nebraska Medical Center. Physician will utilize reasonable efforts to ...

Nebraska Medicine

IM GI - 2026-022

Omaha, NE · On-site

Physician will participate in quality assurance, utilization review, and continuous quality improvement activities of The Nebraska Medical Center. Physician will utilize reasonable efforts to ...

Nebraska Medicine

IM-GI - 2026-245

Omaha, NE · On-site

Physician will participate in quality assurance, utilization review, and continuous quality improvement activities of The Nebraska Medical Center. Physician will utilize reasonable efforts to ...

Nebraska Medicine

IM GI - 2026-021

Omaha, NE · On-site

Physician will participate in quality assurance, utilization review, and continuous quality improvement activities of The Nebraska Medical Center. Physician will utilize reasonable efforts to ...

Nebraska Medicine

IM GI - 2026-026

Omaha, NE · On-site

Physician will participate in quality assurance, utilization review, and continuous quality improvement activities of The Nebraska Medical Center. Physician will utilize reasonable efforts to ...

Nebraska Medicine

IM GI - 2026-025

Omaha, NE · On-site

Physician will participate in quality assurance, utilization review, and continuous quality improvement activities of The Nebraska Medical Center. Physician will utilize reasonable efforts to ...

P3 Health Partners

RN Care Manager

Lincoln, NE · On-site

$85K - $105K/yr

The Care Manager may be responsible for activities overlapping with utilization review and quality ... Collaborates with Medical Management teams regarding care plans and patient's progress * Identifies ...

Sky Mavis

RN Care Manager

Lincoln, NE · On-site

$85 - $105/hr

The Care Manager may be responsible for activities overlapping with utilization review and quality ... Collaborates with Medical Management teams regarding care plans and patient's progress * Identifies ...

Boys Town

Medical Social Worker (PRN)

Omaha, NE · On-site

In a career as a Medical Social Worker, you join us in providing life-changing care to patients ... Participates in Utilization Review Committee and activities. * Assumes the duties of the discharge ...

P3 Health Partners, Inc.

RN Care Manager

Lincoln, NE · On-site

$85 - $105/hr

The Care Manager may be responsible for activities overlapping with utilization review and quality ... Collaborates with Medical Management teams regarding care plans and patient's progress * Identifies ...

Boystown

Medical Social Worker (Part-Time)

Omaha, NE

In a career as a Medical Social Worker, you join us in providing life-changing care to patients ... Participates in Utilization Review Committee and activities. * Assumes the duties of the discharge ...

Boystown

Medical Social Worker (PRN)

Omaha, NE

In a career as a Medical Social Worker, you join us in providing life-changing care to patients ... Participates in Utilization Review Committee and activities. * Assumes the duties of the discharge ...

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Medical Utilization Review information

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 Nebraska?

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

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

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

Medical Utilization Review jobs near you
Infographic showing various Medical Utilization Review job openings in Nebraska as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 17% Part Time, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

Dermatology-2026-216

Nebraska Medicine

Omaha, NE • On-site

$18 - $21.75/hr

Full-time

Re-posted 9 days ago

Nebraska Medicine rating

7.5

Company rating: 7.5 out of 10

Based on 155 frontline employees who took The Breakroom Quiz

232nd of 898 rated healthcare providers

Job description

Serious Medicine is what we do. Being extraordinary is who we are. Every colleague plays a key role in upholding this promise to our patients and their families.
Shift:
First Shift (United States of America)
Physician is responsible for the care and treatment of patients within his medical specialty and professional capabilities and in accordance with the prevailing standards of care. Physician will participate in quality assurance, utilization review, and continuous quality improvement activities of The Nebraska Medical Center. Physician will utilize reasonable efforts to represent The Nebraska Medical Center in Omaha, Nebraska and other communities as requested by the Hospital.
Required Qualifications:
• Prior training and experience to provide, direct, and to supervision patient care required.
• Medical Doctor or Doctor of Osteopathy required.
• Successful completion of post-graduate training in a specialty and/or subspecialty residency and/or fellowship program accredited by the ACGME (Accreditation Council for Graduate Medical Education) or other entity acceptable to The Nebraska Medical Center's Medical Staff Executive and Credentials Committee Policies/Standards required.
• Possess excellent verbal and written communication skills.
• Able to handle multiple competing priorities.
• Must hold and continue to hold unrestricted license to practice medicine and a license to prescribe controlled substances in the state of Nebraska and other states as requested by the Nebraska Medical Center.
• Must hold Board Certification with applicable specialty or subspecialty as outlined by The Nebraska Medical Center's and or Bellevue Medical Center's Medical Staff Credentialing and Privileging Policies.
• Meet the requirements for membership on the medical staff at The Nebraska Medical Center and/or Bellevue Medical Center required.
Nebraska Medicine is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, marital status, sex, age, national origin, disability, genetic information, sexual orientation, gender identity and protected veterans' status.

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