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Utilization Review Analyst Jobs (NOW HIRING)

Discovery Institute

Utilization Review

Marlboro, NJ · On-site

Position Summary The Utilization Review (UR) Specialist is responsible for obtaining and ... Strong analytical and critical thinking skills. * Excellent customer service and professional ...

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

... analytical, process-driven environment. Experience in utilization review or case management is ... highly beneficial, particularly within workers' compensation. Clinical experience involving ...

Acrisure

Utilization Review Nurse

Bradenton, FL

... analytical, process-driven environment. Experience in utilization review or case management is ... highly beneficial, particularly within workers' compensation. Clinical experience involving ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

... analytical, process-driven environment. Experience in utilization review or case management is ... highly beneficial, particularly within workers' compensation. Clinical experience involving ...

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Utilization Review Analyst information

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$73.3K

$130K

How much do utilization review analyst jobs pay per year?

As of Sep 1, 2026, the average yearly pay for utilization review analyst in the United States is $73,261.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,500.00 and $87,000.00 per year, depending on experience, location, and employer.

What is a utilization review analyst?

A Utilization Review Analyst is a healthcare professional who evaluates medical records and treatment plans to ensure that patients receive appropriate and cost-effective care. They review cases to determine medical necessity, compliance with insurance guidelines, and adherence to clinical standards. Utilization Review Analysts often work with healthcare providers, insurance companies, and regulatory agencies to optimize resource use and manage healthcare costs. Their work helps prevent unnecessary procedures and supports quality patient outcomes.

What are the key skills and qualifications needed to thrive as a utilization review analyst, and why are they important?

To thrive as a Utilization Review Analyst, you need a solid understanding of healthcare regulations, medical terminology, and case management, typically supported by a degree in nursing, healthcare administration, or a related field. Familiarity with electronic medical records (EMR) systems, utilization management software, and certifications like Certified Professional in Utilization Review (CPUR) are often required. Analytical thinking, attention to detail, and strong communication skills help you effectively assess medical necessity and collaborate with healthcare providers. These skills ensure accurate and compliant review processes, leading to optimal patient care and efficient resource utilization.

What are some common challenges utilization review analysts face when coordinating with clinical and administrative staff?

Utilization Review Analysts often encounter challenges when balancing differing priorities between clinical providers and administrative policies. For example, clinicians may advocate for extended patient care based on medical judgment, while analysts must ensure that care aligns with insurance and regulatory guidelines. Effective communication and collaboration are essential, as analysts must diplomatically resolve discrepancies and provide clear rationale for decisions. Building strong relationships with both teams helps streamline the review process and fosters a collaborative work environment.

What is the difference between Utilization Review Analyst vs Claims Analyst?

AspectUtilization Review AnalystClaims Analyst
CredentialsTypically requires healthcare-related certifications, such as RHIA or RHITOften requires insurance or claims processing certifications, like CPC or CPC-A
Work EnvironmentHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare payers, third-party administrators
Industry UsageUsed in healthcare and insurance sectors for reviewing medical necessityUsed in insurance and claims processing for evaluating claims

While both roles involve healthcare and insurance, a Utilization Review Analyst focuses on assessing the medical necessity of services, whereas a Claims Analyst handles processing and evaluating insurance claims. Both roles require understanding healthcare policies, but their daily tasks and focus areas differ.

Is utilization review a good job?

Utilization Review Analysts evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires strong analytical skills, attention to detail, and knowledge of healthcare policies, with typical work hours being standard business times. Job satisfaction depends on individual preferences for healthcare-related work and the ability to handle administrative tasks and compliance standards.

What degree do I need for utilization review analyst?

A utilization review analyst typically needs at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Relevant certifications, such as the Certified Professional in Healthcare Quality (CPHQ) or nursing licensure, can enhance job prospects. Strong analytical skills and knowledge of medical terminology and insurance processes are also important.
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Utilization Review Analyst jobs near you
Infographic showing various Utilization Review Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $73,261 per year, or $35.2 per hour.

Utilization Review Analyst

EAGLEVILLE HOSPITAL

Eagleville, PA • On-site

Other

Re-posted 4 days ago

Job description

Eagleville Hospital, an independent substance use and behavioral health treatment and educational organization serving the community for more than a century, provides innovative compassionate care to those seeking treatment for stigmatized illnesses including substance use and mental health.
Position Summary
Review and abstract pertinent data from medical records and communicates information to all various insurance companies and/or their contractual agencies to guarantee continued financial coverage.
This position reports to the Utilization Review Director
Objectives / Responsibilities
  • Reviews admissions to determine medical necessity and appropriateness of treatment.
  • Reviews patient records to obtain justification of treatment.
  • Secures necessary data from the clinical team for extended stay reviews.
  • Presents abstracts (via telecon) of clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment.
  • Review, abstracts and assigns initial length of stay and extensions of treatment as appropriate for all payers as assigned
  • Communicates all extensions of treatment to clinical teams and Director, Utilization Review (UR)
  • Notify clinical teams of need for current documentation.
  • Refer cases to Director, UR when appropriateness of and necessity of extended stay is questionable.
  • Attend appropriate daily treatment team meeting
  • Salary Range: $50-$57/yr

Educational Requirements
  • Bachelor's Degree Preferred

Competencies
  • Patient-Centered Approach - Treat all individuals with dignity, empathy, and respect, recognizing that every role contributes to the patient experience.
  • Excellence & Accountability - Perform all duties with professionalism, following hospital policies to ensure safety, compliance, and efficiency.
  • Teamwork & Communication - Collaborate with colleagues across departments, maintaining a positive and solution-oriented attitude.
  • Commitment to Our Mission - Uphold the hospital's values and contribute to a culture of trust, inclusivity, and continuous improvement.

Qualifications
  • 3+ years of UR or case management experience in Substance Use /Behavioral Health
  • Good communication
  • Ability to work independently
  • Experience with Microsoft applications
  • Knowledge of pre-certification process and ASAM. Knowledge of DSM V, private care managers and county referral sources

Physical Requirements
  • Ability to sit for long periods
  • Ability to walk around campus if needed
  • Good dexterity, must be able to type
  • Use of telephone

Work Environment
  • Office setting

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