Utilization Review Nurse
Murray, UT · On-site +1
Demonstrated team leadership, relationship building, critical analysis, and written and verbal ... One year Utilization Review or Case Management experience. Licenses Required * Current license to ...
Utilization Review Nurse
Murray, UT · On-site +1
Demonstrated team leadership, relationship building, critical analysis, and written and verbal ... One year Utilization Review or Case Management experience. Licenses Required * Current license to ...
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 ...
Quick apply
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 ...
Utilization Review Nurse
Las Vegas, NV · On-site
Duties include analyzing medical charts, determining whether care provided is within established ... Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies ...
Quick apply
Utilization Review Nurse
Las Vegas, NV · On-site
Duties include analyzing medical charts, determining whether care provided is within established ... Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies ...
Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations ... Strong analytical, communication, and documentation skills * Proficiency with electronic medical ...
Quick apply
Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations ... Strong analytical, communication, and documentation skills * Proficiency with electronic medical ...
... utilization review and discharge planning. Essential Functions : * Facilitates communication ... Must know how to gather and analyze data. Must be articulate, assertive, and able to communicate ...
... utilization review and discharge planning. Essential Functions : * Facilitates communication ... Must know how to gather and analyze data. Must be articulate, assertive, and able to communicate ...
Utilization Review RN
Boston, MA · On-site
$38.11 - $98.61/hr
... in analyzing, updating, and modifying procedures and processes to continually improve utilization review operations. 9. Maintains professional and technical knowledge by attending educational ...
Utilization Review RN
Boston, MA · On-site
$38.11 - $98.61/hr
... in analyzing, updating, and modifying procedures and processes to continually improve utilization review operations. 9. Maintains professional and technical knowledge by attending educational ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Maintain accurate records, compile reports, and support utilization review program operations ... Strong analytical and critical thinking skills to assess clinical appropriateness and compliance
Maintain accurate records, compile reports, and support utilization review program operations ... Strong analytical and critical thinking skills to assess clinical appropriateness and compliance
... analyze large datasets i, Strong written communication skills with experience drafting executive summaries i, Deep understanding of utilization review methodologies and medical necessity criteria (e ...
... analyze large datasets i, Strong written communication skills with experience drafting executive summaries i, Deep understanding of utilization review methodologies and medical necessity criteria (e ...
Maintain accurate records, compile reports, and support utilization review program operations ... Strong analytical and critical thinking skills to assess clinical appropriateness and compliance
Maintain accurate records, compile reports, and support utilization review program operations ... Strong analytical and critical thinking skills to assess clinical appropriateness and compliance
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Utilization Review activities include inpatient, observation, outpatient in a bed, ambulatory ... analysis. * Leads quality improvement initiatives, including audits and mock inspections, to ...
Utilization Review activities include inpatient, observation, outpatient in a bed, ambulatory ... analysis. * Leads quality improvement initiatives, including audits and mock inspections, to ...
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 ...
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 ...
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 ...
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 ...
Utilization Review Analyst information
See salary details
$31K - $40K
11% of jobs
$40K - $49K
9% of jobs
$52.1K is the 25th percentile. Wages below this are outliers.
$49K - $58K
15% of jobs
$58K - $67K
15% of jobs
The median wage is $67.3K / yr.
$67K - $76K
18% of jobs
$82.5K is the 75th percentile. Wages above this are outliers.
$76K - $85K
11% of jobs
$85K - $94K
7% of jobs
$94K - $103K
5% of jobs
$103K - $112K
4% of jobs
$112K - $121K
2% of jobs
$121K - $130K
3% of jobs
$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?
| Aspect | Utilization Review Analyst | Claims Analyst |
|---|---|---|
| Credentials | Typically requires healthcare-related certifications, such as RHIA or RHIT | Often requires insurance or claims processing certifications, like CPC or CPC-A |
| Work Environment | Hospitals, insurance companies, healthcare organizations | Insurance companies, healthcare payers, third-party administrators |
| Industry Usage | Used in healthcare and insurance sectors for reviewing medical necessity | Used 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:
- Remote Occupational Therapy Utilization Review
- Free Utilization Review Training
- Aetna Utilization Review Nurse
- Remote Utilization Review Nurse Practitioner
- Full Time Anthem Utilization Review Nurse
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- Internship Rn Utilization Review Nurse
Full-time
Posted 9 days ago
Key responsibilities
Applies approved utilization criteria to monitor appropriateness of admissions and continued stay review.
Communicates with third-party payers for initial and concurrent clinical review and documents all actions shared with care team members or payers.
Refers cases that surpass expected length of stay, cost, or resource utilization to the Utilization Review committee and prepares appeals on denied cases when appropriate.
University Of Utah Health rating
7.7
Based on 140 frontline employees who took The Breakroom Quiz
159th of 877 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
Qualifications
Required
Qualifications (Preferred)
Preferred
Employee must be able to meet the following requirements with or without an accommodation.
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
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.
- 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.
- 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.
Qualifications (Preferred)
Preferred
- Knowledge of ICD-10, CPT Codes, and medications HCPCS
- Knowledge of CMS Regulations.
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
What University Of Utah Health employees say
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