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Utilization Review Analyst Jobs (NOW HIRING)

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary ... Duties include analyzing medical charts, determining whether care provided is within established ...

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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 Aug 11, 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 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 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 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.

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 Coder (CPC) or Certified Utilization Review Professional (CURP), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and data analysis tools is also important.
More about Utilization Review Analyst jobs
What job categories do people searching Utilization Review Analyst jobs look for? The top searched job categories for Utilization Review Analyst jobs are:
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, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $73,261 per year, or $35.2 per hour.

Utilization Review Representative

Wyoming Valley Behavioral Health

Kingston, PA • On-site

$25 - $35/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 26 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.