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Medical Utilization Review Jobs (NOW HIRING)

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role ... You will perform frequent case reviews, check medical records and speak with care providers ...

ARcare

Utilization Review Associate

Augusta, AR · On-site

Utilization Review Associate Job Type: Full-time, 40 hours per week required (hourly POSITION ... Able to learn and utilize electronic medical record, electronic data systems, and electronic ...

ARcare

Utilization Review Associate

Augusta, AR · On-site

Utilization Review Associate Job Type: Full-time, 40 hours per week required (hourly POSITION ... Able to learn and utilize electronic medical record, electronic data systems, and electronic ...

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 ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role ... You will perform frequent case reviews, check medical records and speak with care providers ...

New

PARKSIDE INC

Utilization Review Specialist

Tulsa, OK · On-site

The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to ... Coordinates with clinicians, business office and medical records to achieve above goals.

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

Mountain City, TN · On-site

Utilization Review Coordinator Position Summary Mountain Youth Academy is nestled in Mountain City ... Excellent Medical, Dental, Vision and Prescription Drug Plans * 401(K) with company match and ...

UHS

Utilization Review Coordinator

Mountain City, TN

Utilization Review Coordinator Position Summary Mountain Youth Academy is nestled in Mountain City ... Excellent Medical, Dental, Vision and Prescription Drug Plans * 401(K) with company match and ...

UHS

Utilization Review Clinician

Augusta, GA

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

New

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 ...

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Medical Utilization Review information

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$42

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How much do medical utilization review jobs pay per hour?

As of Jul 24, 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.

Is being a MOA a good entry level job?

Medical Office Assistants (MOAs) often serve as entry-level healthcare support roles, requiring basic administrative and clinical skills. The position can provide valuable experience in medical settings and may lead to advancement with additional training or certifications. However, job responsibilities and requirements vary by employer and location.

What jobs pay 4000 a week without a degree?

Medical Utilization Review roles typically require relevant healthcare knowledge and certifications but may not always require a degree. High-paying jobs that can reach $4,000 a week without a degree include sales positions, real estate brokers, commercial pilots, and certain skilled trades like electricians or plumbers with experience. These roles often depend on experience, performance, or licensing rather than formal education.

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 utilization review a stressful job?

Medical utilization review can be stressful due to the need for accuracy, meeting strict deadlines, and managing complex cases. The role often requires attention to detail, critical thinking, and sometimes working under pressure, but stress levels vary depending on workload and work environment.

What qualifications do you need to be a utilization review nurse?

A utilization review nurse typically needs a registered nurse (RN) license, which requires completing an accredited nursing program and passing the NCLEX-RN exam. Relevant experience in case management, insurance, or clinical settings, along with knowledge of healthcare regulations and utilization review processes, is also important. Certification in case management or utilization review, such as the Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects.

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 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 July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 14% Part Time, and 7% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Nurse

Utilization Review Nurse

Oscar Health

Tempe, AZ • Remote

$35 - $45.94/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 12 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

237th of 281 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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