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Medicare Utilization Review Jobs (NOW HIRING)

LCMC Health

... utilization of healthcare services through timely and accurate medical necessity reviews. * Serves ... Maintains compliance with Medicare, Medicaid, and other payer requirements while supporting ...

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UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL

... Medicare/Medicaid Must be familiar with community based resources need to coordinate aftercare ... Utilization Review position, such as: * Challenging and rewarding work environment * Competitive ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

The Director of Utilization Management is also responsible for ensuring that the utilization review ... Medicare/Medicaid Must be familiar with community based resources need to coordinate aftercare ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Health Plan (OHP), Medicare, and applicable regulations. The UM Nurse collaborates with ...

UHS

Director of Utilization Review

Salt Lake City, UT · On-site

One to Five (1-5) years required of related experience, with e xpert knowledge of utilization review processes, managed care, Medicare, and Medicaid requirements. One to Five (1-5) years preferred of ...

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How much do medicare utilization review jobs pay per hour?

As of Jul 24, 2026, the average hourly pay for medicare 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.

What are the typical daily responsibilities of someone working in Medicare Utilization Review?

In a Medicare Utilization Review role, your day-to-day tasks often include reviewing patient medical records to ensure services meet Medicare coverage criteria, evaluating the necessity and efficiency of proposed treatments, and communicating findings with healthcare providers. You’ll also submit detailed reports, coordinate with physicians, case managers, and insurance representatives, and follow up on documentation requests. Frequently, you’ll participate in interdisciplinary team meetings to discuss patient care plans and recommend alternative treatments if needed. This role requires balancing regulatory compliance with effective healthcare delivery, making each day dynamic and rewarding.

What are the key skills and qualifications needed to thrive in the Medicare Utilization Review position, and why are they important?

To thrive as a Medicare Utilization Review professional, you need a solid background in healthcare (often as an RN or LPN), strong analytical skills, and familiarity with Medicare regulations and guidelines. Experience using utilization management software, electronic health records (EHRs), and claim review systems like InterQual or MCG is typically required. Strong attention to detail, effective communication, and negotiation skills help set candidates apart. These competencies are crucial to ensure compliance, promote accurate claims processing, and support optimal patient care decisions within Medicare standards.

What is a Medicare Utilization Review job?

A Medicare Utilization Review job involves evaluating healthcare services to ensure they meet Medicare guidelines for medical necessity, cost-effectiveness, and quality of care. Professionals in this role review patient records, treatment plans, and insurance claims to determine appropriate coverage and prevent fraud or overutilization. They work closely with healthcare providers and insurance companies to ensure compliance with federal regulations. This role helps maintain the integrity of Medicare services while optimizing patient care and cost efficiency. Strong analytical skills and knowledge of medical coding, billing, and Medicare policies are essential for success in this position.

More about Medicare Utilization Review jobs
What cities are hiring for Medicare Utilization Review jobs? Cities with the most Medicare Utilization Review job openings:
What states have the most Medicare Utilization Review jobs? States with the most job openings for Medicare Utilization Review jobs include:
What job categories do people searching Medicare Utilization Review jobs look for? The top searched job categories for Medicare Utilization Review jobs are:
Medicare Utilization Review jobs near you
Infographic showing various Medicare Utilization Review job openings in the United States as of July 2026, with employment types broken down into 3% As Needed, 78% Full Time, 15% Part Time, and 4% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Nurse (RN)

Utilization Review Nurse (RN)

Madera Community Hospital

Madera, CA • On-site

$55.34 - $66.41/hr

Full-time

Posted 6 days ago

Job description

Madera Community Hospital
Located in the heart of Central California, Madera Community Hospital is a General Acute Care, private, not-for-profit hospital dedicated to improving and maintaining the health and wellness of residents throughout the Central Valley. We are committed to identifying and serving our community's needs with compassion, concern, care and safety for every patient. Madera Community Hospital is a growing acute care facility seeking talented individuals with a drive to provide quality care and dedicated to making a difference in our community.
Position Summary: The Utilization Review Nurse assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, Nursing, patient and family who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.
Qualifications:
  • Minimum of 1-3 years of related acute care nursing experience and completion of an accredited nursing program required.
  • Experience with Meditech Electronic Health Record (EHR) system preferred.
  • Must have working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
  • Ability to maintain collaborative working relationships to ensure a positive and productive work environment.
  • Ability to plan and prioritize work with frequent interruptions.
  • Ability to provide exceptional customer service.
  • Effective verbal and written communication skills.
  • Knowledge and proficiency of hospital information technology applications.
  • Requires Current California Board of Nursing Registered Nurse License.
  • Current American Heart Association BCLS certificate required; ACLS certificate preferred.
  • CCM in Case Management preferred.

Madera Community Hospital provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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