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Urgently Hiring Insurance Utilization Review Jobs

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review ...

Ova Technologies

Utilization Review Nurse

Alpharetta, GA · On-site

Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience: 2 ... Communicate with insurance companies, managed care organizations, and third-party payers regarding ...

New

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

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All JobsUrgently Hiring Insurance Utilization Review Jobs

Urgently Hiring Insurance Utilization Review information

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How much do urgently hiring insurance utilization review jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for urgently hiring insurance 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 Urgently Hiring Insurance Utilization Review vs Insurance Claims Processor?

AspectUrgently Hiring Insurance Utilization ReviewInsurance Claims Processor
Primary RoleAssess medical necessity and appropriateness of services for insurance coverageReview and process insurance claims for payment and reimbursement
Required CredentialsLicenses or certifications in health insurance or medical review, often with healthcare backgroundKnowledge of insurance policies, claims processing systems, and basic healthcare understanding
Work EnvironmentHealthcare or insurance companies, often in office or remote settingsInsurance companies, healthcare providers, or third-party claims processing centers
Common Search/ComparisonUrgently Hiring Insurance Utilization Review vs Insurance Claims Processor

While both roles involve insurance and healthcare, Insurance Utilization Review focuses on evaluating the necessity of medical services, whereas Insurance Claims Processors handle the processing and payment of claims. Understanding these differences helps job seekers find the right position aligned with their skills and credentials.

What is an insurance utilization review?

An Insurance Utilization Review is a process used by insurance companies and healthcare organizations to evaluate the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. Professionals in this role review patient records, treatment plans, and coverage policies to determine if the requested healthcare services meet established criteria for payment and care. Their work helps control healthcare costs, ensures quality care, and supports compliance with regulations. They often collaborate with physicians, nurses, and insurance providers to make informed decisions. Typically, strong analytical, communication, and clinical knowledge are required for this job.

What are the main challenges faced by professionals in insurance utilization review, and how can they be addressed?

One of the main challenges in Insurance Utilization Review is balancing the need to ensure appropriate patient care with the necessity of complying with insurance coverage criteria. This often involves interpreting complex medical records and guidelines under tight deadlines, while communicating effectively with healthcare providers and payers. Building strong organizational and communication skills, and staying updated on changing insurance policies and regulations, can help professionals navigate these challenges successfully. Collaboration with clinical teams and ongoing professional development are also key to thriving in this fast-paced environment.

What are the key skills and qualifications needed to thrive as an insurance utilization review specialist?

To excel as an Insurance Utilization Review Specialist, you generally need a healthcare background (often as an RN, LPN, or similar credential), strong analytical skills, and in-depth knowledge of medical terminology and insurance guidelines. Familiarity with utilization management software, electronic medical records (EMR), and certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Exceptional attention to detail, critical thinking, and effective communication with both healthcare providers and insurers set top performers apart. These skills ensure accurate coverage determinations, compliance with regulations, and cost-effective patient care management.
What cities are hiring for Urgently Hiring Insurance Utilization Review jobs? Cities with the most Urgently Hiring Insurance Utilization Review job openings:
What are the most commonly searched types of Insurance Utilization Review jobs? The most popular types of Insurance Utilization Review jobs are:
What states have the most Urgently Hiring Insurance Utilization Review jobs? States with the most job openings for Urgently Hiring Insurance Utilization Review jobs include:
Urgently Hiring Insurance Utilization Review jobs near you

Utilization Review Representative

Wyoming Valley Behavioral Health

Kingston, PA

$25 - $35/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 22 days ago

Job description

As Wyoming Valley Behavioral Health continues to expand, we’re excited to add an experienced full-time Utilization Review Representative to our growing Utilization Review department. The person will be responsible for reviewing and analyzing patient care to ensure the appropriate use of resources, adherence to clinical guidelines, and compliance with regulatory requirements.

Responsibilities:

·         Conduct thorough reviews of patient records and treatment plans to assess the necessity and appropriateness of medical services and interventions.

·         Evaluate clinical documentation to ensure it meets established standards and guidelines for care.

·         Collaborate with healthcare providers to discuss treatment plans and recommend modifications as needed to optimize patient outcomes and resource utilization.

·         Prepare and maintain detailed documentation of reviews, including rationale for decisions and recommendations for care adjustments.

·         Serve as a liaison between the facility and insurance companies or other third party payers to manage authorizations and claims.

·         Prepare and present reports on utilization metrics, including patterns, outcomes, and recommendations for process improvements.

Education:

·         Associate’s degree or higher in Nursing, Healthcare Administration or a related field

Qualifications:

·         Minimum of 1-2 years of experience in a healthcare setting, with a strong background in utilization review, case management, or clinical nursing.

·         Licensed RN/LPN preferred

·         Knowledge of clinical guidelines, regulatory requirements, and healthcare reimbursement processes.

·         Excellent analytical skills and attention to detail, with the ability to review and interpret complex clinical information.

·         Strong communication and interpersonal skills, with the ability to work collaboratively with healthcare professionals and external stakeholders.

·         Proficient in electronic health record (EHR) systems and utilization review software.

·         Certification in Utilization Review or related field (e.g., URAC, CCM) is a plus.

Exciting Benefits Await You:

·         Attractive Compensation: Enjoy competitive pay that truly values your contributions.

·         Generous Paid Time Off: Recharge and prioritize your well-being with ample PTO.

·         401(k) Plan: Secure your financial future with our strong retirement plan.

·         Flexible Daily Pay: Access your earnings whenever you need them.

·         Comprehensive Benefits Package: Benefit from a wide range of options, including dental, health, vision, and disability insurance.

·         Wellness Program Access: Prioritize your health with resources designed to support your well-being.

·         Inclusive Workplace Culture: Thrive in a supportive environment that champions diversity and collaboration.

·         Career and Educational Development: Unlock your potential with numerous opportunities for growth and advancement.

·         Comprehensive Onboarding and Professional Development Programs: Expertly crafted to cultivate growth and significantly enhance essential skills, paving the way for sustained success and excellence.


Salary/ Wage Range

Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies and experience and may fall outside of the range shown. 

EEO Statement

We are committed to maintaining a diverse and inclusive workplace. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for our job opportunities.