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Utilization Review Analyst Jobs (NOW HIRING)

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.

GRO Community

Utilization Review Manager

Chicago, IL · On-site

Utilization Review Manager Location: Chicago Job Type: Full-Time Reports to: Director of Revenue ... Monitor and analyze denial trends, proactively identifying opportunities to improve documentation ...

GRO Community

Utilization Review Manager

Chicago, IL

Utilization Review Manager Location: Chicago Job Type: Full-Time Reports to: Director of Revenue ... Monitor and analyze denial trends, proactively identifying opportunities to improve documentation ...

GRO Community

Utilization Review Manager

Chicago, IL · On-site

Utilization Review Manager Location: Chicago Job Type: Full-Time Reports to: Director of Revenue ... Monitor and analyze denial trends, proactively identifying opportunities to improve documentation ...

Winston Medical Staffing

Be Seen First

Utilization Review Nurse

Newark, NJ · Remote

$38 - $40/hr

Evaluates care by problem solving, analyzing variances and participating in the quality improvement ... utilization, case and/or disease management processes. - Requires knowledge of health care ...

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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 Jul 21, 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.

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 July 2026, with employment types broken down into 66% Full Time, 4% Part Time, and 30% Contract. Highlights an 61% Physical, 5% Hybrid, and 34% Remote job distribution, with an average salary of $73,261 per year, or $35.2 per hour.
Utilization Review Coordinator

Utilization Review Coordinator

Port St. Lucie Hospital

Port Saint Lucie, FL

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 6 days ago

Job description

Utilization Review Coordinator

Location: Everwell Port St. Lucie Hospital, Inc

Position Summary

Everwell Port St. Lucie Hospital is seeking a detail-oriented Utilization Review Coordinator to coordinate insurance reviews, monitor patient authorizations, and support effective communication between the hospital, physicians, and insurance providers.

Key Responsibilities

  • Review all patients’ admissions on a daily basis to determine necessity and appropriateness of placement services as outlined in Plans and Procedures.

  • Assigns continued stay reviews according to criteria; reviews continued stay at least every ten (10) to fourteen (14) days and certified pursuant to approved criteria.

  • Maintains a system for monitoring all admissions to assure timely reviews; collects and records all necessary information/data for review of admission, continued stay, and utilization of services.

  • Reviews patient records upon request of insurance companies and communicates patient condition and treatment to external utilization review offices.

  • Contacts physicians and primary Nurses for clarification of information as necessary.

  • Assures appropriate Authorization of Release of Information forms are obtained prior to releasing information to insurance companies.

  • Completes mental health treatment reports and other reports, including appeal letters, required by insurance companies for review of patient care and treatment as requested.

  • Monitors information that is copied and sent per request to insurance companies for inpatient and assures that only required information is disseminated.

  • Contacts physicians, primary Nurses and other appropriate staff regarding potential problems or questions related to documentation of patient care issues.

  • Coordinates and schedules all PRO reconsideration hearings and schedules appropriate staff to attend hearings.

  • Coordinates the assemblage of records for review by Federal State, Professional and appropriate hospital groups.

  • Performs special projects or other related work as required or requested.

  • Shows ability to communicate in a clear and concise manner.                       

  • Demonstrates ability to work with others.

  • Adapt to changing situations or work assignments.

  • Demonstrates willingness to rotate to other areas of hospital within the limits of preparation and skill level.

  • Conform to uniform and dress code, personal hygiene and good grooming.

  • Wear and properly display name badge.                                                                 

  • Positively respond to guidance or counseling and attempts to benefit by it.

  • Adept in identifying potential problems within the department and seeks management guidance.

  • Demonstrates excellent organizational skills and originator of new ideas and methods.

  • Use verbal and non-verbal communication with others, i.e., courtesy, tone of voice, facial expressions, gestures, etc.

  • Demonstrates an understanding of and adherence to the Code of Conduct

  • Conduct reflects Oglethorpe’s values and a commitment to the Code of Conduct

Qualifications and Education

  • RN, LPN or Master's Level Clinician with experience

  • CPR Certification required

  • Minimum 2 years of healthcare experience preferred

  • Knowledge of utilization review processes and medical terminology

  • Experience working with insurance companies and behavioral health

    documentation preferred

  • Ability to use data collection techniques, and statistical computations.

  • Strong communication, organizational, and analytical skills

  • Familiarity with DSM criteria and healthcare compliance standards preferred

  • Thorough knowledge of effective and appropriate charting principles

    Work Environment

    • Primarily indoor, temperature-controlled healthcare environment

    • Collaborative team-focused setting

      Benefits

    • Medical, Dental and Vision insurance

    • 401K

    • PTO and Sick time

    This position requires a pre-employment Level 2 Background check: https://info.flclearinghouse.com