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Medical Utilization Review Jobs in Ohio (NOW HIRING)

Prime Time Healthcare

Utilization Review

Cleveland, OH · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

Now Hiring: RN Utilization Review - Middleburg Heights, OH Are you a passionate RN professional ... Medical, Vision & Dental insurance * 401(k) Matching Program * Flexible Schedules * Travel ...

Nationwide Children's Hospital

Reviews behavioral health cases to determine medical necessity and appropriateness of care ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...

Lifepoint Health

Specialist, Utilization Review

Columbus, OH · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Comprehensive medical, dental, and vision plans, plus flexible-spending and health- savings ... Professional development and growth opportunities How you'll contribute Utilization Review ...

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All JobsMedical Utilization Review JobsMedical Utilization Review Jobs in Ohio

Medical Utilization Review information

See Ohio salary details

$20

$40

$65

How much do medical utilization review jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for medical utilization review in Ohio is $40.20, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $46.15 per hour, depending on experience, location, and employer.

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.

Is medical utilization review a stressful job?

Medical utilization review can be stressful due to the need to evaluate complex medical cases, meet strict deadlines, and ensure accurate decisions. The job often requires attention to detail, critical thinking, and sometimes handling difficult interactions with providers or patients. However, stress levels vary depending on workload, work environment, and individual coping skills.

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.

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 Reimbursement Specialist (CMRS) can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and billing systems.

What does a medical utilization review specialist do in healthcare?

A medical utilization review specialist evaluates healthcare services to determine their necessity, efficiency, and appropriateness based on established guidelines. They review patient records, collaborate with healthcare providers, and ensure compliance with insurance policies, often using specialized software. This role helps control healthcare costs and ensures quality patient care.

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.

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 popular job titles related to Medical Utilization Review jobs in Ohio?

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

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

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

Medical Utilization Review jobs near you
Infographic showing various Medical Utilization Review job openings in Ohio as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 12% Part Time, and 8% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $83,610 per year, or $40.2 per hour.

Utilization Review

Prime Time Healthcare

Cleveland, OH • On-site

Other

Medical, Dental, Vision, Retirement

Posted 10 days ago

Job description

Now Hiring: RN Utilization Review - Middleburg Heights, OH

Are you a passionate RN professional looking for a new adventure? Prime Time Healthcare is seeking dynamic individuals like you to join our team in Middleburg Heights, OH and make a real impact in patient care!

In this role, you'll be at the forefront of healthcare, delivering top-notch care with precision and compassion. As an integral part of our team, you'll collaborate closely with fellow healthcare professionals, ensuring every patient receives the highest level of care possible.

If you're ready to elevate your career and make a difference in the lives of others, apply today!

At Prime Time Healthcare, we offer competitive compensation along with a large range of benefits including:

  • Competitive compensation and weekly direct deposit
  • Compliance Support Specialist & Onboarding Assistance
  • Dedicated recruiter for personalized support
  • Paid, safe, pet-friendly lodging (if applicable)
  • Round-the-clock customer support 24/7
  • Unlimited referral bonus up to $750
  • Medical, Vision & Dental insurance
  • 401(k) Matching Program
  • Flexible Schedules
  • Travel Discounts

Prime Time Healthcare, LLC is an Equal Opportunity Employer (EOE).

*Estimated pay and benefits packages are on a per facility basis and may change with market conditions. Exact pay and benefits package will be negotiated with Prime Time Healthcare and may vary with several factors including but not limited to, guaranteed hours, travel distance, demand, eligibility, etc.

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About PrimeTime Healthcare

Sourced by ZipRecruiter

PrimeTime Healthcare, based in Omaha, NE, US, is a leading provider of staffing solutions in the healthcare industry. According to information accessed from their official website, primetimehealthcare.com, the company specializes in placing high-quality healthcare professionals into temporary and travel positions across a vast network of healthcare facilities nationwide. Founded in 2012, PrimeTime Healthcare quickly established a reputation for customer-focused and result-oriented services, earning it a place on Staffing Industry Analyst’s fastest-growing staffing companies list.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Omaha, NE, US

Year founded

2012

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