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Utilization Review Analyst Jobs (NOW HIRING)

MNCP Staffing

Utilization Review Nurse

Las Vegas, NV

Duties include analyzing medical charts, determining whether care provided is within established ... Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies ...

Sevita

Utilization Review Specialist

Akron, OH · On-site

$40K/yr

SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... Monitors strategies * Provides report analysis of actual service deliveries in comparison to ...

UK St Claire

Utilization Review Nurse

Morehead, KY · On-site +1

Supports utilization review processes by planning, analyzing data, and setting goals to ensure appropriate reimbursement and adherence to guidelines. Essential Functions • Abstracts and assembles ...

UHS

Utilization Review Coordinator

West Columbia, SC · On-site

Minimum of two years psychiatric experience in chart analysis and in the utilization review field. Excellent oral and written communication skills required in order to communicate in a clear and ...

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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 Nurse

Utilization Review Nurse

University of Utah Health

Murray, UT • On-site, Remote

Full-time

Re-posted 2 days ago

University Of Utah Health rating

7.7

Company rating: 7.7 out of 10

Based on 140 frontline employees who took The Breakroom Quiz

158th of 886 rated healthcare providers

Job description

Overview
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA
This position is responsible for maintaining the financial integrity of both the patient and the organization through the provision of quality based patient care focusing on the medical necessity and efficiency of the delivery of such care; achieved via managing the cost of care while providing timely and accurate information to third party payers and medical care team. This position may be required to access and administer medications within their scope of practice and according to state law.
Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.
Responsibilities
Essential Functions
  • Applies approved utilization criteria to monitor appropriateness of admissions with associated levels of care and continued stay review.
  • Communication to third-party payers for initial and concurrent clinical review.
  • Reviews patient chart to ensure patient continues to meet medical necessity.
  • Documentation of all actions and information shared with care team members or third-party payer.
  • Alerts and discusses with physician/provider and case manager/discharge planner when patient no longer meets medical necessity criteria for the inpatient stay.
  • Discusses with physicians the appropriateness of resource utilization.
  • Tracks length of stay (LOS) and resource utilization to identify at risk patients.
  • Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources.
  • Performs verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration with the payer per university contractual obligation.
  • Participant in UR Committee as needed.
  • Collects data on variances in LOS, avoidable days, costs/barriers to discharge/transition and denied days.
  • Prepares appeals on denied cases when appropriate.
  • At the discretion of department operational and patient care needs, this position is required to work rotating schedules, which may include variable hours, weekends, nights, and holidays to meet the staffing and patient care demands of a 24/7 complex health system. Regular, reliable, and punctual attendance during assigned shifts is considered an essential function of the role.
Knowledge / Skills / Abilities
  • Demonstrated availability to work variable and rotating shifts, including nights, weekends, and holidays, in a 24/7 patient care environment.
  • Ability to perform the essential functions of the job as outlined above.
  • Demonstrated team leadership, relationship building, critical analysis, and written and verbal communication skills.
  • Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria.
  • The ability to demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.
  • Ability to work autonomously and as a team member.

Qualifications
Required
  • One year Utilization Review or Case Management experience.
Licenses Required
  • Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 days of hire under the interstate compact if switching residency to State of Utah. Must maintain current Interstate Compact (multi-state) license if residency is not being changed to Utah.
* Additional license requirements as determined by the hiring department.
Qualifications (Preferred)
Preferred
  • Knowledge of ICD-10, CPT Codes, and medications HCPCS
  • Knowledge of CMS Regulations.
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
  • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions. This position does not provide care to patients.

Physical Requirements
Carrying, Color Determination, Crawling, Far Vision, Lifting, Listening, Manual Dexterity, Near Vision, Pulling and/or Pushing, Reaching, Sitting, Speaking, Standing, Stooping and Crouching, Walking

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