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Medicare Utilization Review Jobs (NOW HIRING)

Hired by Matrix

RN Utilization Review

Portales, NM · On-site

Job Title: RN Utilization Review City: Portales State: NM Job Type: Travel Discipline: RN ... for Medicare, Medicaid, HMO, swing bed and private insurance coverage * Initiate ongoing ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Demonstrates a solid understanding of managed care, Medicare, and Medicaid regulations. * Schedule:

Actalent

Utilization Review Nurse

$30 - $40/hr

RN Clinical Review Nurse (Utilization Review Nurse) The Clinical Review Clinician for Appeals is ... Knowledge of NCQA, Medicare, and Medicaid regulations. * Knowledge of utilization management ...

TEKsystems

Utilization Review Specialist

Addison, TX · On-site

$70K - $100K/yr

Utilization review experience Additional Skills & Qualifications * Perform utilization review ... Ensure compliance with Medicare, commercial payer, and regulatory guidelines. * Identify ...

AbsoluteCARE

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Demonstrates a solid understanding of managed care, Medicare, and Medicaid regulations. * Schedule:

Albanymed

Utilization Review Nurse

Albany, NY

$77K - $119K/yr

While performing utilization review identifies areas for clinical documentation improvement and ... Working knowledge of Medicare regulatory requirements, Managed Care Plans Thank you for your ...

MNCP Staffing

Utilization Review Nurse

Las Vegas, NV · On-site

Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes ...

Albany Med

Utilization Review Nurse

Albany, NY · On-site

$77K - $119K/yr

... utilization review identifies areas for clinical documentation improvement and contacts appropriate ... Medicare regulatory requirements, Managed Care Plans Thank you for your interest in Albany Med ...

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Medicare Utilization Review information

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$68

How much do medicare utilization review jobs pay per hour?

As of Sep 3, 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 is a Medicare Utilization Review?

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.

What does a Medicare Utilization Review do?

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 Medicare Utilization Review?

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.

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?

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What job categories do people searching Medicare Utilization Review jobs look for?

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Medicare Utilization Review jobs near you
Infographic showing various Medicare Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Registered Nurse - Utilization Review (Remote)

Talencia

Torrance, CA • On-site

$57/hr

Contractor

Re-posted 12 days ago

Job description

Job Title: RN - Utilization Review (Remote) 
Location: Remote – Must work in Pacific Standard Time (PST)
Duration: 13 Weeks
Unit: Remote Utilization Management
Pay Rate: $54/hr (W2) or $57/hr (1099)
 
Shift & Schedule
  • Schedule: Monday to Friday, 5x8-Hour Days
  • Hours: 08:00 AM – 04:30 PM (PST)
  • Weekend Requirement: Every third weekend
Position Summary
We are seeking a Registered Nurse (RN) with a strong background in Utilization Review to work remotely.
This role involves reviewing medical necessity, documentation, and level of care decisions across multiple hospitals and service lines.
Key Responsibilities
  • Perform utilization review for inpatient, observation, and extended outpatient cases
  • Apply InterQual criteria (required – Hardstop)
  • Use Epic for documentation and review workflows (recent use within 6–12 months required)
  • Interpret and apply Medicare rules and documentation (e.g., CC44s, ABNs, HINNs, MCSNs)
  • Rotate across three hospital systems under centralized UM
  • Adhere to California labor laws (breaks, meals, and time reporting)
Required Qualifications
  • Active CA RN License
  • Minimum 3 years of acute care CM/UM experience in a hospital setting (not health plan or medical group)
  • InterQual experience (Hardstop)
  • Recent Epic use (within the last 6–12 months)
  • Strong understanding of Medicare, HMO, and IPA processes
  • High attention to detail, organizational, and communication skills
  • Comfortable working independently in a fully remote environment