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Non Clinical Utilization Review Jobs (NOW HIRING)

WVU Medicine

Clinical Utilization Management Pharmacist

$121K - $144K/yr

Participate in the appeals process for drug reviews for all lines of business. * Own the ... Exempt/Non-Exempt: United States of America (Exempt) Company: PHH Peak Health Holdings Cost Center ...

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 ...

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

... to non-clinical precertification staff. * Assists with delayed claims review to determine ... Prefer recent utilization management or case management experience. Licensure Requirement: Current ...

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

... to non-clinical precertification staff. * Assists with delayed claims review to determine ... Prefer recent utilization management or case management experience. Licensure Requirement: Current ...

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How much do non clinical utilization review jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for non clinical 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 the difference between Non Clinical Utilization Review vs Clinical Utilization Review?

AspectNon Clinical Utilization ReviewClinical Utilization Review
CredentialsTypically requires healthcare administration, insurance, or case management certificationsRequires clinical licenses such as RN, MD, or other healthcare provider credentials
Work EnvironmentOffice-based, insurance companies, or healthcare organizationsHospitals, clinics, or healthcare facilities
Employer & Industry UsageInsurance companies, third-party administrators, healthcare organizationsHospitals, clinics, healthcare providers
Search & Comparison IntentUnderstanding administrative and insurance-focused review rolesUnderstanding clinical decision-making and patient care review roles

Non Clinical Utilization Review involves assessing healthcare services from an administrative perspective, focusing on insurance policies and coverage. Clinical Utilization Review involves healthcare professionals evaluating patient care and clinical necessity. Both roles are essential in healthcare but differ mainly in credentials, work environment, and focus area.

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What states have the most Non Clinical Utilization Review jobs?

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The top searched job categories for Non Clinical Utilization Review jobs are:

Non Clinical Utilization Review jobs near you
Infographic showing various Non Clinical Utilization Review job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

UR Clinical Associate

Carteret Health Care

Morehead City, NC • On-site

Full-time

Re-posted 11 days ago

Carteret Health Care rating

6.8

Company rating: 6.8 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

600th of 1,060 rated hospitals

Job description

  • JOB RELATIONSHIPS

    • This position reports to the Director of Research & Innovation. Works closely with and directly supports the Utilization Review Specialist (RN), Care Management staff, physicians, Vice President of Medical Affairs, CDI, Revenue Cycle, Patient Access, and the Business Office. This role serves as the clinical support bridge between the non-clinical UR administrative function and the licensed RN UR Specialist, operating under the supervision of licensed nursing staff for all clinically related tasks.

  • DEFINITION OF POSITION

    • The Utilization Review Clinical Associate (URCA) provides clinically informed support to the inpatient Utilization Review (UR) team at Carteret Health Care. This role is distinguished from the non-clinical Utilization Review Support Specialist (URSPEC) by requiring an active clinical license or credential and by performing functions that require clinical knowledge and judgment at a support level, under the supervision and direction of the RN UR Specialist. The URCA assists with concurrent review activities, functional and discharge readiness assessment support, clinical documentation coordination, level-of-care data collection, and payer communication support. The URCA does not independently perform medical necessity determinations or make inpatient/observation status decisions; those functions remain with the RN UR Specialist and Physician Advisor. The URCA enhances team capacity by bridging clinical and administrative UR functions, reducing burden on licensed UR nursing staff, and contributing clinical perspective to care transitions and discharge planning coordination.

  • QUALIFICATIONS
    • Professional
      • Active clinical license or credential required. Qualifying credentials include: Licensed Practical Nurse (LPN), Physical Therapist (PT), Occupational Therapist (OT), Physical Therapist Assistant (PTA), Certified Occupational Therapy Assistant (COTA), Speech-Language Pathologist (SLP), Respiratory Therapist (RT), Medical Assistant (CMA/RMA), or equivalent clinically credentialed healthcare professional. Credential must be in good standing with the applicable state licensing board.
      • Preferred (2) years of clinical experience in an acute care hospital, rehabilitation, skilled nursing, or related inpatient/post-acute setting preferred.
      • Working knowledge of medical terminology, clinical documentation, and patient care workflows in an inpatient environment.
      • Familiarity with insurance terminology, prior authorization processes, and payer-specific concurrent review requirements preferred.
      • Familiarity with CMS rules relevant to inpatient care (e.g., Two-Midnight Rule, inpatient vs. observation status, Important Message from Medicare, MOON notice) preferred; training will be provided.
      • Proficiency with Microsoft Office (Outlook, Word, Excel) and ability to learn hospital information systems (Meditech, Midas, Providerlink, payer portals).
      • A certification such as Certified Case Manager (CCM), Certified Utilization Review Professional (CURP), or Certified Revenue Cycle Specialist (CRCS) is a plus but not required.

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About Carteret Health Care

Sourced by ZipRecruiter

Welcome to Carteret Health Care in Morehead City on the Crystal Coast of North Carolina. Come for the lifestyle, stay for the rewarding career. Imagine being able to live, work and play at the beach. Enjoying a wonderful quality of life, great recreational activities and excellent schools. As part of our mission to promote wellness and service to our community through exceptional quality and compassionate care, our employees are committed to our 'Navigating to Excellence' performance improvement initiative. We offer competitive employee benefits and salaries. Please consider joining our dedicated team — and make a difference every day.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Morehead City, NC, US

Year founded

1967

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