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Occupational Therapy Utilization Review Jobs (NOW HIRING)

ECU Health

Utilization Review Specialist

Greenville, NC · On-site

$65K - $95K/yr

Position Summary The Utilization Review Specialist will ensure regulatory compliance with CMS ... occupational health screening, criminal record check, education, reference, and licensure ...

Umpqua Health

Utilization Review Clinician

UTILIZATION REVIEW CLINICIAN REMOTE Ability to travel on-site to 3031 NE STEPHENS ST. ROSEBURG, OR ... Licensed Marriage and Family Therapist (LMFT) * Registered Nurse (RN) with Behavioral Health ...

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Cascadia of Boise

Occupational Therapy

Boise, ID · On-site

$38.25 - $50.50/hr

Contribute to facility patient care, utilization review, case management, administrative staff ... Provides skilled occupational therapy services / interventions in accordance with physician orders.

Boise of Cascadia, LLC

Occupational Therapy

Boise, ID · On-site

$38.25 - $50.50/hr

Contribute to facility patient care, utilization review, case management, administrative staff ... Provides skilled occupational therapy services / interventions in accordance with physician orders.

Boise of Cascadia, LLC

Occupational Therapy

Boise, ID · On-site

$38.25 - $50.50/hr

Contribute to facility patient care, utilization review, case management, administrative staff ... Provides skilled occupational therapy services / interventions in accordance with physician orders.

Cascadia of Boise

Occupational Therapy

Boise, ID · On-site

$38.25 - $50.50/hr

Contribute to facility patient care, utilization review, case management, administrative staff ... Provides skilled occupational therapy services / interventions in accordance with physician orders.

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Occupational Therapy Utilization Review information

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How much do occupational therapy utilization review jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for occupational therapy utilization review in the United States is $45.37, according to ZipRecruiter salary data. Most workers in this role earn between $38.70 and $50.96 per hour, depending on experience, location, and employer.

What is occupational therapy utilization review?

Occupational Therapy Utilization Review is a process where an occupational therapy professional evaluates the necessity, efficiency, and appropriateness of therapy services provided to patients. This role involves reviewing clinical documentation and treatment plans to ensure compliance with insurance and regulatory guidelines, as well as determining if services are medically necessary. The goal is to optimize patient care while also controlling healthcare costs and ensuring ethical practices. Utilization reviewers often work for insurance companies, healthcare organizations, or third-party review agencies, and may interact with therapists to clarify documentation or recommend changes to treatment plans.

What are the key skills and qualifications needed to thrive as an occupational therapy utilization review specialist, and why are they important?

To thrive as an Occupational Therapy Utilization Review specialist, you need a solid clinical background in occupational therapy, a valid OT license, and experience in case management or utilization review. Familiarity with electronic medical records (EMR) systems, insurance guidelines, and certifications such as CCM (Certified Case Manager) or URAC accreditation are often required. Strong critical thinking, attention to detail, and effective communication skills help professionals excel in evaluating treatment plans and collaborating with healthcare teams. These competencies ensure that care recommendations are evidence-based, cost-effective, and compliant with insurance and regulatory standards.

What is the difference between Occupational Therapy Utilization Review vs Occupational Therapist?

AspectOccupational Therapy Utilization ReviewOccupational Therapist
CredentialsTypically requires a background in occupational therapy, often with certification in utilization review or case managementRequires a state license and a master's degree in occupational therapy
Work EnvironmentPrimarily office-based, reviewing cases for insurance companies or healthcare organizationsClinical settings such as hospitals, clinics, or rehabilitation centers
Employer & IndustryInsurance companies, healthcare organizations, case management firmsHospitals, outpatient clinics, rehabilitation centers
Job FocusEvaluating medical necessity and approving or denying therapy servicesProviding direct therapy services to patients to improve daily functioning

Occupational Therapy Utilization Review focuses on assessing the necessity of therapy services through case evaluation, often in an office setting. In contrast, Occupational Therapists provide hands-on therapy to patients. While both roles require knowledge of occupational therapy, their work environments and responsibilities differ significantly.

What are some common challenges faced in an occupational therapy utilization review role, and how can they be addressed?

One common challenge in Occupational Therapy Utilization Review is balancing the need to ensure cost-effective care with advocating for appropriate patient services. Professionals in this role often navigate complex clinical documentation and must communicate effectively with both therapy providers and insurance representatives. Staying current on evolving payer guidelines and clinical best practices is essential. Developing strong analytical skills and fostering collaborative relationships with clinical teams can help address these challenges and support both patient outcomes and organizational goals.

What are utilization review jobs in occupational therapy?

Occupational therapy utilization review jobs focus on reviewing clinical records and documentation to ensure that patients of occupational therapists receive required services and an appropriate level of clinical care. Your duties also include collecting information for insurance purposes. In addition to insurance reimbursement and claim data, you also assess the available resources and staff skills in the facility that you are reviewing. Utilization review specialists can look at medical data, but they can also interview a patient or communicate with the occupational therapists who provide treatment to come up with evidence-based reports to support their review.

More about Occupational Therapy Utilization Review jobs
What cities are hiring for Occupational Therapy Utilization Review jobs? Cities with the most Occupational Therapy Utilization Review job openings:
What are the most commonly searched types of Occupational Therapy Utilization Review jobs? The most popular types of Occupational Therapy Utilization Review jobs are:
What states have the most Occupational Therapy Utilization Review jobs? States with the most job openings for Occupational Therapy Utilization Review jobs include:
What job categories do people searching Occupational Therapy Utilization Review jobs look for? The top searched job categories for Occupational Therapy Utilization Review jobs are:
Occupational Therapy Utilization Review jobs near you
Infographic showing various Occupational Therapy 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 $94,375 per year, or $45.4 per hour.

Utilization Review Specialist

BriteLife Recovery

Englewood, NJ • On-site

Full-time

Re-posted 14 days ago

Job description

) What you will be doing?
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD) treatment at Britelife Recovery. This role ensures timely approvals and continued stay authorizations from insurance payers by effectively communicating clinical information and advocating for appropriate levels of care.
The UR Specialist works closely with clinical staff, admissions, medical providers, and third-party payers to support patient access to treatment and maintain financial viability for the organization. Success in this role requires strong clinical judgment, documentation skills, familiarity with ASAM criteria, and a working knowledge of insurance guidelines specific to behavioral health
What tasks are required?
  • Conduct initial and concurrent reviews for detox, residential, partial hospitalization (PHP), and intensive outpatient (IOP) levels of care.
  • Obtain prior authorizations and continued stay approvals from commercial and other payers by submitting timely clinical reviews and documentation.
  • Communicate clinical necessity of services based on ASAM criteria and DSM-5 diagnoses.
  • Track and document all insurance-related communications, decisions, and outcomes in the EHR and UR logs.
  • Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up-to-date clinical information for reviews.
  • Ensure treatment plans, progress notes, and assessments are completed on time and accurately reflect medical necessity.
  • Participate in multidisciplinary team meetings to stay informed on client progress and treatment goals.
  • Assist staff with proper documentation practices to support insurance justification and compliance.
  • Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols.
  • Monitor trends in denials, approvals, and length-of-stay metrics to support organizational performance improvement.
  • Assist in appeals and peer reviews by gathering required documentation and preparing clinical summaries.
  • Provide training and support to staff on documentation best practices related to utilization review.
  • Special projects as assigned

What we need from you?
  • Minimum of 2-3 years of experience in utilization review, case management, or insurance coordination in a behavioral health or substance use treatment setting.
  • Knowledge of ASAM criteria and levels of care for substance use and co-occurring disorders.
  • Familiarity with managed care principles, insurance authorizations, and payer requirements.
  • Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
  • Excellent organizational, communication, and time management skills.
  • Proficiency in Electronic Health Records (EHRs), insurance portals, and Microsoft Office tools.
  • Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
  • Experience or working knowledge with Collaborative MD and KIPU
  • Experience in detox and residential SUD programs.
  • Knowledge of major insurance provider platforms (e.g., Optum, Aetna, BCBS, Cigna).
  • Strong clinical writing skills and familiarity with medical necessity language.
  • Ability to advocate for clients while balancing payer relationships and compliance.
  • Ability to lift up to 25 pounds.
  • Ability to walk up and down stairs during emergency drills or situations.

All ARS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. ARS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

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