SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... Monitors strategies * Provides report analysis of actual service deliveries in comparison to ...
SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... Monitors strategies * Provides report analysis of actual service deliveries in comparison to ...
We are currently seeking a Utilization Review Manager to join our Transitional Care Team. This is a ... Ability to lead, delegate, analyze information and problem solve * Demonstrates evidence of strong ...
We are currently seeking a Utilization Review Manager to join our Transitional Care Team. This is a ... Ability to lead, delegate, analyze information and problem solve * Demonstrates evidence of strong ...
Utilization Review Nurse
Omaha, NE · Hybrid
The Utilization Review Nurse ensures all aspects of an injured worker's treatment are effective ... Able to read, analyze, and interpret common scientific and technical journals, statutes ...
Utilization Review Nurse
Omaha, NE · Hybrid
The Utilization Review Nurse ensures all aspects of an injured worker's treatment are effective ... Able to read, analyze, and interpret common scientific and technical journals, statutes ...
Utilization Review Nurse
Las Vegas, NV · On-site
$40.72 - $63.12/hr
Duties include analyzing medical charts, determining whether care provided is within established ... Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies ...
Utilization Review Nurse
Las Vegas, NV · On-site
$40.72 - $63.12/hr
Duties include analyzing medical charts, determining whether care provided is within established ... Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies ...
Utilization Review Specialist
Akron, OH · On-site
$40K/mo
SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... Monitors strategies * Provides report analysis of actual service deliveries in comparison to ...
Utilization Review Specialist
Akron, OH · On-site
$40K/mo
SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... Monitors strategies * Provides report analysis of actual service deliveries in comparison to ...
Services include analysis of medical records, data and participation in committees as requested. 9. ... Maintains Utilization Review files and logs in a neat, accurate and orderly form. 12. Provides ...
Services include analysis of medical records, data and participation in committees as requested. 9. ... Maintains Utilization Review files and logs in a neat, accurate and orderly form. 12. Provides ...
Utilization Review Nurse
$35 - $50/hr
... standards • Analyze benefit structures and system configurations (EZCap or similar) • ... all claim review activities • Participate in special projects related to claim denials and ...
Utilization Review Nurse
$35 - $50/hr
... standards • Analyze benefit structures and system configurations (EZCap or similar) • ... all claim review activities • Participate in special projects related to claim denials 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 ...
Services include analysis of medical records, data and participation in committees as requested. 9. ... Maintains Utilization Review files and logs in a neat, accurate and orderly form. 12. Provides ...
Services include analysis of medical records, data and participation in committees as requested. 9. ... Maintains Utilization Review files and logs in a neat, accurate and orderly form. 12. Provides ...
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
$35 - $50/hr
... standards • Analyze benefit structures and system configurations (EZCap or similar) • ... all claim review activities • Participate in special projects related to claim denials and ...
Utilization Review Nurse
$35 - $50/hr
... standards • Analyze benefit structures and system configurations (EZCap or similar) • ... all claim review activities • Participate in special projects related to claim denials and ...
We are currently seeking a Utilization Review Manager to join our Transitional Care Team. This is a ... Ability to lead, delegate, analyze information and problem solve * Demonstrates evidence of strong ...
We are currently seeking a Utilization Review Manager to join our Transitional Care Team. This is a ... Ability to lead, delegate, analyze information and problem solve * Demonstrates evidence of strong ...
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
$29 - $30/hr
Applies knowledge and expertise, analytical skills, critical thinking and business acumen to best ... Utilization Review/Management, HEDIS, Chart Auditing, Medical Record Reviews] Additional ...
Utilization Review Nurse
$29 - $30/hr
Applies knowledge and expertise, analytical skills, critical thinking and business acumen to best ... Utilization Review/Management, HEDIS, Chart Auditing, Medical Record Reviews] Additional ...
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
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 ...
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 5, 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?
| 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:
- Utilization Review
- Aetna Utilization Review Nurse
- International Utilization Review Nurse
- Remote International Utilization Review Nurse
- Free Utilization Review Training
- Cigna Utilization Review Nurse
- Full Time Anthem Utilization Review Nurse
- Optum Utilization Review Nurse
- Remote Utilization Review
- Utilization Review Management
$40K/mo
Other
Posted 18 days ago
Job description
Salary: $ $40,170.00
Location: Akron(Portage Lakes area)
Schedule: Mon/Tue/Wed/Thur/Fri 8:30 AM - 5:00 PM
OUR MISSION AND PERFORMANCE EXPECTATIONS
The MENTOR Network is a mission-based organization dedicated to providing high quality services to those we serve. Therefore, to deliver on our mission, The Network expects every employee to perform his or her job first and foremost in accordance with the Company’s mission.
SUMMARYThe Utilization Review Specialist is responsible for proactive planning measures, accurate documentation of services delivered for audit assurances, and positive outcomes regarding effective service utilization to customers. Provides professional oversight of service delivery authorizations and assurances, effective tracking and timely recommendations in regards to service delivery utilization parameters, and quality assurance of service delivery records on an ongoing basis.
ESSENTIAL JOB FUNCTIONS
To perform this job successfully, an individual must be able to satisfactorily perform each essential function listed below:
- Develops plans to accurately measure documentation of services delivered to assure compliance with auditors
- Oversees service delivery authorizations and provides quality assurances of service delivery records
- Recommends service delivery utilization parameters
- Maintains knowledge of updated funding Rules and Contracts
- Notifies internal stakeholders for any updated information on service delivery, authorizations, and utilization of services
- Maintains organized and complete records and assures quality focused service delivery method strategies
- Monitors the regional office and storage filing systems
- Organizes records including availability for compliance audit file review
- Provides technical assistance to clinical staff in the service areas
- Facilitates timely and appropriate service authorization
- Monitors strategies
- Provides report analysis of actual service deliveries in comparison to authorized service approvals
- May direct and supervise clerical and administrative staff
- Provides feedback on performance evaluations
- Conducts scheduling, orientation, and training
- Resolves issues and serves as resource
- Performs other related duties and activities as required
SUPERVISORY RESPONSIBILITIES
May direct and supervise clerical and administrative staff, including performance evaluations, scheduling, orientation, and training. Provides feedback on employee performance and resolves issues within position responsibilities.
Minimum Knowledge and Skills required by the Job
The requirements listed below are representative of the knowledge, skill, and/or abilities required to perform the job:
Education and Experience:
- Bachelor’s degree required
- 1 year minimum work experience in human services required
Certificates, Licenses, and Registrations:
- None
Other Skills and Abilities:
- For Ohio – Basic Excel skills and ability to learn the Ohio state billing software
Other Requirements:
- Travel as needed
Physical Requirements:
- Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
AMERICANS WITH DISABILITIES STATEMENT
External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job functions either unaided or with assistance of a reasonable accommodations to be determined on a case by case basis.