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Medstar Health Utilization Review Jobs (NOW HIRING)

Prime Time Healthcare

Utilization Review

Washington, DC · On-site

Now Hiring: RN Utilization Review - Washington, DC Are you a passionate RN professional looking for ... Prime Time Healthcare is seeking dynamic individuals like you to join our team in Washington, DC ...

Prime Healthcare

Utilization Review Tech

Lynwood, CA · On-site

$23 - $24.45/hr

Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our ... Utilization review tech is responsible for coordinating phone calls, data entry and tracking data ...

Houston Healthcare

$80 - $100/hr

Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of ... Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

Utilization Review Nurse Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

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Medstar Health Utilization Review information

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How much do medstar health utilization review jobs pay per hour?

As of Sep 10, 2026, the average hourly pay for medstar health 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 MedStar Health utilization review?

A Medstar Health Utilization Review is a process used by Medstar Health to evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. Utilization review professionals assess patient records, treatment plans, and insurance requirements to ensure that patients receive the right care at the right time, while also helping to manage healthcare costs. This process helps maintain quality standards, prevent unnecessary treatments, and ensure compliance with regulations and payer policies.

What are some common challenges faced by utilization review professionals at MedStar Health, and how can these be managed?

Utilization Review professionals at Medstar Health often encounter challenges such as keeping up with frequently changing healthcare regulations, managing high caseloads, and ensuring effective communication with both clinical teams and insurance providers. Successfully managing these challenges typically involves staying current with industry guidelines through ongoing education, utilizing support from multidisciplinary teams, and leveraging Medstar Health’s robust electronic health record systems. Building strong collaboration skills and being proactive in documenting reviews can also help streamline workflows and improve efficiency.

What are the key skills and qualifications needed to thrive as a utilization review specialist at MedStar Health, and why are they important?

To thrive as a Utilization Review Specialist at MedStar Health, you need a clinical background (such as RN or LPN licensure), strong knowledge of medical necessity criteria, and experience in case management or utilization review. Familiarity with electronic medical records (EMR) systems, InterQual or MCG guidelines, and regulatory compliance tools is typically required. Attention to detail, critical thinking, and effective communication are essential soft skills for collaborating with healthcare teams and ensuring accurate assessments. These skills and qualifications ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within the healthcare system.

What is the difference between Medstar Health Utilization Review vs Medstar Health Case Manager?

AspectMedstar Health Utilization ReviewMedstar Health Case Manager
Primary RoleAssessing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning
CredentialsRN, licensed healthcare professionalRN, social worker, or licensed healthcare professional
Work EnvironmentInsurance companies, hospitals, or health plansHospitals, clinics, or community health settings
FocusUtilization review and approvalPatient advocacy and care coordination

While both roles involve healthcare professionals, Medstar Health Utilization Review focuses on evaluating the necessity of services, whereas Medstar Health Case Managers coordinate ongoing patient care and discharge planning. Both roles require similar credentials and often work within the same healthcare environment, but their primary responsibilities differ.

What are popular job titles related to Medstar Health Utilization Review jobs?

For Medstar Health Utilization Review jobs, the most frequently searched job titles are:

Infographic showing various Medstar Health Utilization Review job openings in the United States as of September 2026, with employment types broken down into 2% As Needed, 77% Full Time, 16% Part Time, and 5% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Specialist

Lucedale, MS • On-site

ADDICTION AND MENTAL HEALTH SERVICES, LLC
See more jobs at ADDICTION AND MENTAL HEALTH SERVICES, LLCexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

Key responsibilities

  • Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services.

  • Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details.

  • Make informed decisions regarding authorization, continuation, or denial of services based on clinical guidelines, policies, and regulatory requirements.

Job description

About Company:

We’re officially a Great Place To Work®! We’ve always believed that supporting our team is just as important as supporting our patients. Now, we’re proud to share that we’ve earned Great Place To Work® Certification - based entirely on feedback from our own employees.

Read more here: https://ow.ly/YQ1C50WuRH1

This certification reflects the culture we’ve worked hard to build - one rooted in trust, inclusion, and purpose-driven leadership.

At Bradford Health Services, we are committed to providing exceptional care to our patients while fostering a supportive and rewarding workplace for our employees. We believe that taking care of our team allows them to take better care of others, which is why we offer a comprehensive benefits package designed to support their well-being.

Our benefits include:

  • Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits.

  • Expanded Coverage – Options for domestic partners and a wider network of in-network providers.

  • Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching.

  • Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more.

  • Student Loan Repayment – Available for nurses and therapists.

  • Retirement Benefits – 401(k) plan through Voya to help employees plan for the future.

  • Generous PTO – A robust paid time off policy to support work-life balance.

  • Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.

At Bradford Health Services, we don’t just invest in our patients—we invest in our people.



About the Role:

The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of patient records, treatment plans, and clinical data to determine the appropriateness of care and resource utilization. The specialist collaborates closely with healthcare providers, insurance companies, and case managers to facilitate timely approvals and optimize patient outcomes. By applying clinical knowledge and analytical skills, the role helps to control healthcare costs while maintaining high-quality patient care. Ultimately, the Utilization Review Specialist contributes to the integrity and sustainability of healthcare delivery systems across the United States.

Minimum Qualifications:

  • Bachelor’s degree in Nursing, Health Administration, or a related healthcare field.
  • At least 2 years of experience in utilization review, case management, or clinical healthcare roles.
  • Strong knowledge of medical terminology, clinical procedures, and healthcare regulations.
  • Familiarity with insurance authorization processes and utilization management guidelines.
  • Excellent communication and analytical skills with attention to detail.

Preferred Qualifications:

  • Registered Nurse (RN) license or relevant clinical certification.
  • Experience working with electronic health record (EHR) systems and utilization review software.
  • Certification in Utilization Review (e.g., Certified Professional in Utilization Review or Certified Case Manager).
  • Knowledge of specific payer policies and healthcare reimbursement models.
  • Advanced training in healthcare compliance and quality assurance.

Responsibilities:

  • Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services.
  • Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details.
  • Make informed decisions regarding authorization, continuation, or denial of services based on clinical guidelines, policies, and regulatory requirements.
  • Document findings and decisions accurately in electronic health record systems and prepare detailed reports for internal and external stakeholders.
  • Stay current with healthcare regulations, insurance policies, and clinical best practices to ensure compliance and effective utilization management.

Skills:

The Utilization Review Specialist uses clinical expertise and analytical skills daily to evaluate patient care plans and determine medical necessity. Strong communication skills are essential for collaborating effectively with healthcare providers and insurance representatives to gather information and explain decisions. Attention to detail ensures accurate documentation and compliance with regulatory standards. Proficiency with electronic health records and utilization management software facilitates efficient case review and reporting. Additionally, staying informed about healthcare policies and clinical guidelines enables the specialist to make well-informed, ethical decisions that balance patient care quality with cost containment.

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