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Physical Therapy Utilization Review Jobs (NOW HIRING)

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

Knowledge, Skills, Abilities, and Physical Requirements Knowledge of: Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint ...

KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the ... Medical Terminology preferred Physical Requirements: * Body Positions: Sitting and standing for ...

UHS

Director of Utilization Review

Gulfport, MS · On-site

Current license in the state of Missisippi, including RN, LMSW, LMFT, LPC EEO Statement All UHS ... and the utilization review process including concurrent reviews. Previous continuum of care ...

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Physical Therapy Utilization Review information

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

As of Aug 15, 2026, the average hourly pay for physical therapy utilization review in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.

What are some common challenges faced in a physical therapy utilization review role, and how can I prepare for them?

Professionals in Physical Therapy Utilization Review often face the challenge of balancing clinical judgment with payer guidelines and policies. Reviewing cases requires strong attention to detail, as well as the ability to interpret medical records efficiently while ensuring compliance with insurance requirements. You may also encounter situations where you need to communicate complex decisions to clinicians or patients, so strong communication and negotiation skills are essential. Staying current with evidence-based practices and insurer protocols will help you navigate these challenges effectively.

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

AspectPhysical Therapy Utilization ReviewPhysical Therapist
CredentialsTypically requires a license in healthcare or related field, with additional training in utilization reviewRequires a state license as a licensed physical therapist, with DPT degree
Work EnvironmentMostly office-based, reviewing patient records and insurance claimsClinical settings, hospitals, outpatient clinics, providing direct patient care
Employer & Industry UsageInsurance companies, healthcare organizations, utilization review companiesHospitals, outpatient clinics, rehab centers, private practices

Physical Therapy Utilization Review focuses on evaluating the necessity and appropriateness of physical therapy services for insurance and healthcare compliance, often working behind the scenes. In contrast, a Physical Therapist provides direct patient care, developing treatment plans and performing therapy sessions. Both roles require healthcare knowledge, but their daily tasks and work environments differ significantly.

What are the key skills and qualifications needed to thrive as a physical therapy utilization review specialist?

To thrive as a Physical Therapy Utilization Review specialist, you need a solid background in physical therapy, clinical assessment, and knowledge of insurance guidelines, typically requiring a valid PT license and clinical experience. Familiarity with utilization management software, electronic health records (EHR), and compliance documentation systems is often necessary. Strong analytical skills, attention to detail, and clear communication help in evaluating treatment plans and collaborating with providers. These competencies are essential for ensuring appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is physical therapy utilization review?

Physical Therapy Utilization Review is a process in which healthcare professionals evaluate the necessity, efficiency, and appropriateness of physical therapy services provided to patients. Utilization review specialists assess patient records, treatment plans, and progress to ensure that therapy services are evidence-based and meet insurance or regulatory guidelines. This helps control healthcare costs, prevents unnecessary treatments, and ensures patients receive optimal care. Utilization review can be conducted by physical therapists, nurses, or other qualified professionals within insurance companies, hospitals, or third-party organizations.
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Physical Therapy Utilization Review jobs near you
Infographic showing various Physical Therapy Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 18% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 98% Physical, 1% Hybrid, and 1% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.

Director of Utilization Review

Signet Health Corporation

Midland, TX • On-site

Other

Medical, Dental, Vision, Life, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Overview
Director of Utilization Review (RN) - Midland/Odessa, Texas
Signet Health is seeking an experienced Director of Utilization Review (RN) for a new hospital - Permian Basin Behavioral Health Center, located between Midland and Odessa, Texas.
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer requirements, Texas Behavioral Health regulations, and DNV accreditation standards.
The UR RN performs utilization review activities, concurrent reviews, precertifications, and discharge-related authorization functions to support timely reimbursement and high-quality patient care.
Signet Health is one of the larger behavioral health management companies in the United State with programs nation-wide. We are staffing and managing this brand-new hospital.
We offer a competitive and comprehensive compensation package including:
  • Health Insurance - variety of plans
  • Dental Insurance
  • Vision Insurance
  • Life Insurance
  • AD & D Insurance
  • Hospital Indemnity Insurance
  • Critical Illness Insurance
  • HSA
  • FSA
  • Employee Assistance (EAP)
  • Disability Insurance
  • Unlimited PTO
  • 8 Holidays
  • Relocation Assistance

Responsibilities Include:
1.Utilization Management & Medical Necessity
  • Conduct admission, continued-stay, and discharge reviews for all patients based on:
    • InterQual®, MCG, or payer-specific medical necessity criteria.
    • CMS Conditions of Participation (where applicable).
    • DNV NIAHO® Behavioral Health standards.
  • Validate appropriate level of care (inpatient, PHP, IOP, detox, residential).
  • Identify and communicate variances to medical necessity, collaborating with providers to resolve clinical or authorization barriers.

2.Insurance & Authorization Management
  • Initiate pre-certifications for admissions and transfers.
  • Perform concurrent reviews with commercial, Medicaid, Medicare Advantage, and managed care organizations.
  • Submit clinical documentation within required time frames to prevent denials.
  • Manage peer-to-peer requests and escalate cases to physician advisors as needed.
  • Track and document authorization numbers, approved days, and review dates in EMR and UR software.

3.Compliance & Accreditation (DNV / Texas-specific)
  • Ensure UR processes comply with:
    • DNV NIAHO®/ISO 9001 requirements for utilization management.
    • Texas Administrative Code Title 25-Behavioral Health Facility regulations.
    • CMS, EMTALA (if applicable), and payer rules.
  • Participate in audits, tracer activities, and performance improvement projects.
  • Maintain accurate and complete documentation that meets DNV documentation standards.

4.Interdisciplinary Collaboration
  • Work with physicians, nursing, case management, therapy, social work, and admissions to coordinate patient flow and progression of care.
  • Attend daily treatment team meetings on assigned units.
  • Communicate authorization status, updates, and denials to clinical teams.

5.Denial Prevention & Management
  • Identify potential denial risks early and intervene proactively.
  • Assist with preparation of denial appeals, supplying clinical summaries and supporting documentation.
  • Work with billing and revenue cycle to ensure claims accuracy and timely submission.

6.Documentation & Data Management
  • Enter all reviews, payer communications, and clinical updates into the EMR/UR tracking system.
  • Maintain UR logs, KPIs, and dashboards for:

o LOS monitoring
o Denial rates
o Approval trends
o Payer mix and reimbursement
o Report trends to leadership for process improvement
This is an on-site position located in Midland, Texas. All duties are performed on campus.
Requirements/Qualifications
Qualifications:
Required
  • Current Texas RN license (unencumbered).
  • Minimum 2 years psychiatric/behavioral health nursing experience.
  • Experience with utilization review, case management, or managed care.
  • Knowledge of InterQual®/MCG criteria.
  • Strong understanding of behavioral health diagnoses, treatment modalities, and levels of care.
  • Excellent communication and negotiation skills.

Preferred
  • Prior UR/UM experience in a Texas behavioral health facility.
  • Familiarity with DNV Accreditation (NIAHO®/ISO 9001).
  • Experience with Medicaid/Medicare behavioral health authorization processes.
  • Experience with EMRs such as Epic, Cerner, MediTech, or Sigmund.

CORE COMPETENCIES
  • Clinical assessment and critical thinking
  • Knowledge of utilization review criteria
  • Strong professional communication
  • Time management and organization
  • Understanding of behavioral health regulations
  • Accuracy and attention to detail
  • Collaboration and conflict resolution
  • Ethical decision-making

PHYSICAL & WORK REQUIREMENTS
  • Office-based with regular unit rounds and team meetings.
  • Ability to type, sit, or stand for extended periods.
  • Occasional lifting of files or equipment (<20 lbs).
  • Must maintain confidentiality and meet HIPAA, DNV, and Texas regulatory standards.

ADDITIONAL DUTIES
  • Participate in staff training related to utilization management.
  • Support hospital-wide performance improvement projects.
  • Assist with payer education and communication initiatives.
  • Other duties as assigned by the Director of UR or Clinical Leadership.

Hospital/Program Description
The Permian Basin Behavioral Health Center is a mental health facility located between Midland and Odessa. The Center will provide inpatient and outpatient mental health services to help individuals of all ages overcome their challenges. This exciting partnership between Midland County Hospital District and Ector County Hospital District marks the start of a new chapter in the future of behavioral health in the Permian Basin. PBBHC is scheduled to open spring 2026.
Mission Statement:
PBBHC's Mission is to provide high-quality behavioral health services that are accessible to all residents of Permian Basin Region of West Texas and Southeastern New Mexico.

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