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Utilization Review Analyst Jobs (NOW HIRING)

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 ...

University of Utah

Utilization Review Nurse

Demonstrated team leadership, relationship building, critical analysis, and written and verbal ... One year Utilization Review or Case Management experience. Licenses Required * Current license to ...

MNCP Staffing

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 ...

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 ...

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Utilization Review Analyst information

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How much do utilization review analyst jobs pay per year?

As of Aug 11, 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.

What degree do I need for utilization review analyst?

A utilization review analyst typically needs at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Relevant certifications, such as the Certified Professional Coder (CPC) or Certified Utilization Review Professional (CURP), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and data analysis tools is also important.
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 August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $73,261 per year, or $35.2 per hour.

Utilization Review Nurse

US Tech Solutions

Chicago, IL • On-site

Other

Re-posted 17 days ago

Job description

Chicago, IL

Contract

Job Description:

  • Participates in the development and ongoing implementation of QM Work Plan activities.

  • Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives

Responsibilities:

  • Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.

  • Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.

  • Data gathering requires navigation through multiple system applications.

  • Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.

  • Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.

  • Responsible for the review and evaluation of clinical information and documentation.

  • Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.

  • Works Potential Quality of Care cases across all lines of business (Commercial and Medicare).

  • Independently coordinates the clinical resolution with internal/external clinician support as required.

  • Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data

  • Prepares and completes QM documents based on interpretation and application of business requirements

  • Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements

  • Assists in the development and implementation of QM projects and activities

  • Accountable for completing and implementation of QM Work Plan Activities

Experience:

  • 3+ years of experience as an RN

  • Registered Nurse in state of residence

  • Must have prior authorization utilization experience

  • Experience with Medcompass

Skills:

  • MUST HAVE MEDCOMPASS or ASSURECARE exp.

  • MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge.

  • MUST HAVE UM experience, inpatient utilization management review.

  • MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG.

  • MUST HAVE 6 months of Prior Authorization.

Education:

  • Active and unrestricted RN licensure in state of residence

Questionnaire:

  • Do you have experience with Medcompass?

  • Do you have experience with Prior Authorization?

  • Do you have experience with Utilization Review?

  • Do you have an Active Registered Nurse License?

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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About US Tech Solutions

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US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

Social media

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