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Utilization Review Analyst Jobs (NOW HIRING)

Cobalt Benefits Group

Utilization Review Nurse

As a Utilization Review Nurse (UR Nurse), you'll play an important role in helping us offer ... Strong analytical, critical thinking, and problem-solving skills. * Proficiency in Microsoft Office ...

Cobalt Benefits Group

Utilization Review Nurse

As a Utilization Review Nurse (UR Nurse), you'll play an important role in helping us offer ... Strong analytical, critical thinking, and problem-solving skills. * Proficiency in Microsoft Office ...

Sheppard Pratt

Utilization Review Specialist

Towson, MD · On-site

$26.04/hr

Responsible for supporting the utilization review system including data analysis, report writing, and program improvement. * UR Specialist will develop and maintain a VOD Tracking and Receipt system.

US Tech Solutions

Utilization Review Nurse

Chicago, IL · On-site

Improve quality products and services, by using measurement and analysis to process, evaluate and ... MUST HAVE UM experience, inpatient utilization management review. * MUST HAVE 1 YEAR OF UTILIZATION ...

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All JobsUtilization Review Analyst Jobs

Utilization Review Analyst information

See salary details

$31K

$73.3K

$130K

How much do utilization review analyst jobs pay per year?

As of Jun 29, 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 jobs pay 10,000 a month without a degree?

Utilization Review Analysts typically do not earn $10,000 a month without specialized experience or certifications. High-paying roles that can reach this level without a degree often include sales, real estate, or entrepreneurship, which rely on skills, performance, and networks rather than formal education. Some trades or technical roles, such as certain skilled trades or tech sales, may also offer high income with experience and training rather than a degree.

What is a utilization review analyst?

A utilization review analyst evaluates medical services to determine their necessity, appropriateness, and efficiency for insurance companies or healthcare providers. They review patient records, ensure compliance with guidelines, and often use healthcare management software; certification in healthcare or case review is common. This role helps control healthcare costs and supports quality patient care.

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 jobs pay 2000 a day?

Jobs that can pay around $2,000 a day typically include specialized roles such as anesthesiologists, surgeons, corporate lawyers, or senior executives, often requiring advanced degrees, certifications, and significant experience. These positions usually involve high responsibility, long hours, and are found in healthcare, legal, or executive sectors. Freelance consulting or high-level project management in certain industries may also reach this earning level for experienced professionals.

What jobs in the US pay 300,000 a year?

Utilization Review Analysts typically do not earn $300,000 annually; such high salaries are more common in executive, specialized medical, or senior management roles. High-paying healthcare positions like medical directors or specialized surgeons often reach or exceed this level, especially with extensive experience and certifications. Salary levels depend on industry, location, experience, and advanced skills.

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.

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 June 2026, with employment types broken down into 62% Full Time, 13% Part Time, and 25% Contract. Highlights an 75% In-person, and 25% Remote job distribution, with an average salary of $73,261 per year, or $35.2 per hour.
Registered Nurse, Utilization Review

Registered Nurse, Utilization Review

Nascentia Health

Syracuse, NY • On-site

$72K - $83K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 5 days ago

Nascentia Health rating

7.3

Company rating: 7.3 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

The Utilization Review Nurse assists the utilization review process taking on various tasks including data collection of demographic, claim and medical information; analysis; and outcomes reporting. Utilizes standards of care, evidence based practices, Medicare and Medicaid and organizational coverage guidelines to assure members receive high quality, cost efficient health care and services to meet their long term home and community based needs. Performs utilization review in accordance with all state mandated regulations.
Performance Responsibilities and Standards:

  1. Assist with the review of member usage patterns for medical necessity and appropriateness.
  2. Performs continuing review of medical records and supporting documentation for medical necessity where appropriate.
  3. Tracks and analyzes service utilization patterns monthly and compares to regional benchmarks
  4. Reviews appeals and provides notice of determination.
  5. Receives and responds to Office of Temporary and Disability Assistance (OTDA) notifications of Fair Hearings
  6. Prepares for and attends Fair Hearings.
  7. Assist with the development of coverage policy guidelines for MLTC services.
  8. Participates in interdisciplinary collaboration with professional staff.
  9. Creates and facilitates educational programs.
  10. Identifies and collaborates with UR Manager on individual cases
  11. Identifies and collaborates with UR Manager on trends in usage patterns.
  12. Process Notice of Action letters
  13. Performs concurrent, prior service authorizations and retrospective reviews
  14. Analyze per member per month (PMPM) data
  15. Other duties as assigned
Job Qualifications:
  1. Current NYS RN licensure, BSN preferred.
  2. Five or more years of home health care or long term care experience strongly preferred.
  3. Three or more years of utilization management or quality improvement experience preferred.
Professional competencies, skills and abilities:
  1. Excellent relationship management skills
  2. Demonstrated ability to problem solve complex, multifaceted situations
  3. Successfully manage conflict and negotiate a win win solution
  4. Strong organizational, prioritizing and delegation skills
  5. Abstract thinking
  6. Strong communication skills written and verbal
  7. Advocacy focused
  8. Ability to be non-judgmental
  9. Computer literacy with Microsoft office products
Physical Requirements:
  1. Speech, visual, and hearing ability sufficient to express and comprehend written and verbal communication
  2. Ability to sit 90% of the day
  3. Frequent sitting, standing, walking
  4. Pushing, pulling, reaching, kneeling
  5. Bloodborne Pathogens Exposure Determination Category: Category III

Compensation & Benefits:
Competitive Salary [This position is an S03 exempt position with a min-max rate of: $72,415-$83,922/annually] with:
  • 401K with generous Employer match
  • Medical, Dental, Vision plans
  • Tuition Reimbursement for BSN after 6 months of employment
  • Exceptional work/life balance - no rotating shifts
  • Partially funded HSA
  • Employee Recognition Platform
  • Paid Time Off, Holidays, and Extended Sick Leave
  • Short/Long term Disability
  • Employee Assistance Program (EAP)
  • Much More!!

About Nascentia Health:
Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.
Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.
Nascentia Health is an Equal Opportunity Employer (EOE)
Employment is contingent upon negative results of a pre-hire drug screen

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