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Medical Utilization Review Jobs (NOW HIRING)

Sheppard Pratt

Utilization Review Specialist

Towson, MD

$26.04/hr

Responsible for supporting the utilization review system including data analysis, report writing ... Comprehensive medical, dental and vision benefits for benefit eligible positions * 403b retirement ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

Dane Street, LLC

Utilization Review Physician

Active, unrestricted medical license * Prior utilization review experience, preferably in a health plan or IRO environment * Familiarity with InterQual, MCG, and CMS guidelines * Strong clinical ...

UHS

Utilization Review Coordinator

Augusta, GA

Review clinical content of medical records, participate in treatment team meetings, and collaborate ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...

UHS

Utilization Review Coordinator

Augusta, GA · On-site

Review clinical content of medical records, participate in treatment team meetings, and collaborate ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...

Seh

Summary The Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute ...

Genesis HealthCare

The Utilization Review (UR) Analyst is responsible for assuring insurance notification ... Uses information accurately and effectively. 8. Demonstrates understanding of medical terminology ...

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Medical Utilization Review information

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How much do medical utilization review jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for medical utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

How do I get into a utilization review?

To become a medical utilization review specialist, typically a healthcare or insurance background is required, along with knowledge of medical coding and insurance policies. Many employers prefer candidates with a relevant license or certification, such as the Certified Professional in Healthcare Quality (CPHQ) or Certified Medical Reviewer (CMR). Gaining experience in healthcare administration, medical billing, or case management can also improve job prospects in this field.

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 jobs pay 2000 a day?

In the field of Medical Utilization Review, highly experienced professionals such as senior reviewers, medical directors, or consultants can potentially earn around $2,000 per day, especially when working as independent contractors or in specialized consulting roles. These positions often require advanced certifications, extensive experience, and a strong understanding of healthcare policies and insurance processes.

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 jobs pay 10,000 a month without a degree?

Medical Utilization Review professionals can earn around $10,000 per month with experience and certification, often working in healthcare settings reviewing insurance claims and patient care. Other high-paying roles without a degree include sales managers, real estate brokers, and certain skilled trades like commercial pilots or tech sales, which rely on skills, experience, and certifications rather than formal degrees.

What jobs will no longer exist in 2030?

Medical Utilization Review roles are unlikely to disappear by 2030, but automation and AI tools may reduce the need for manual review tasks. Some administrative or repetitive healthcare jobs could be phased out as technology advances, requiring professionals to adapt by developing skills in data analysis and health informatics.

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.
More about Medical Utilization Review jobs
What cities are hiring for Medical Utilization Review jobs? Cities with the most Medical Utilization Review job openings:
What states have the most Medical Utilization Review jobs? States with the most job openings for Medical Utilization Review jobs include:
What job categories do people searching Medical Utilization Review jobs look for? The top searched job categories for Medical Utilization Review jobs are:
Medical Utilization Review jobs near you
Infographic showing various Medical Utilization Review job openings in the United States as of June 2026, with employment types broken down into 96% Full Time, and 4% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Specialist

Utilization Review Specialist

Sheppard Pratt

Towson, MD

$26.04/hr

Full-time

Medical, Dental, Vision, Retirement

Posted 3 days ago

Sheppard Pratt rating

6.4

Company rating: 6.4 out of 10

Based on 42 frontline employees who took The Breakroom Quiz

632nd of 870 rated healthcare providers

Job description

General Summary:

  • Responsible for supporting the utilization review system including data analysis, report writing, and program improvement.
  • UR Specialist will develop and maintain a VOD Tracking and Receipt system. 
  • UR Specialist will maintain an expert level review of client entitlements and billing authorizations. 
  • Also responsible for securing authorizations and tracking entitlements for enrolled clients.

Knowledge, Skills, and Abilities Required:

  • Knowledge of the public mental health system and programs, generally acquired through a bachelor’s degree in Social Work or Psychology or related degree OR (2) years related work experience.
  • Knowledge of computers and spreadsheet software.
  • Experience with Maryland ASO or other utilization review processes.
  • Substantial level of interpersonal skills in order to communicate effectively with outside agencies and internal customers.
  • Good assessment and clinical skills, including a preeminent knowledge of the rehabilitation model.
  • Excellent organization skills.

Benefits:

At Sheppard Pratt, you will work alongside a multi-disciplined team led by a bold vision to change lives. We offer:

  • A commitment to professional development, including a comprehensive tuition reimbursement program to support ongoing education and licensure and/or certification preparation
  • Comprehensive medical, dental and vision benefits for benefit eligible positions
  • 403b retirement match
  • Generous paid-time-off for benefit eligible positions
  • Complimentary Employee Assistance Program (EAP)
  • Generous mileage reimbursement program

The pay range for this position is $18.50/hr minimum to $26.04/hr maximum.  Pay for this position is determined on a number of factors, including but not limited to, years and level of related experience.

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About Sheppard Pratt

Sourced by ZipRecruiter

Sheppard Pratt is the nation's largest private, nonprofit provider of mental health, substance use, special education, developmental disability, and social services. We serve over 70,000 people every year and have over 160 programs in 16 counties throughout the State of Maryland. Our mission is to improve the quality of life of individuals and families by compassionately serving their mental health, addiction, special education, and community support needs. U.S. News & World Report has ranked Sheppard Pratt as one of the top psychiatric hospitals in the nation for the past thirty years. ! Sheppard Pratt is committed to fostering a safe, welcoming, and diverse environment for employees and patients, and recently earned the "LGBTQ Health Care Equality Top Performer" designation from the Human Rights Campaign Foundation. Sheppard Pratt currently has 5,000 employees, and we are always looking to add compassionate and caring members to our team. If you are someone who is interested in behavioral health, psychology, education, nursing, or social work, Sheppard Pratt is the right fit for you."

Industry

Offices of mental health practitioners

Company size

5,001 - 10,000 Employees

Headquarters location

Baltimore, MD, US

Year founded

1853

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