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Utilization Review Assistant Jobs (NOW HIRING)

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing ... Mobility to move throughout the office or client sites to assist patients as needed Mindful Health ...

Genesis HealthCare

The Utilization Review (UR) Analyst is responsible for assuring insurance notification ... efficiency. 12. Assist with department schedules, assignments and payroll, as needed.

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... We provide customized Independent Medical Exams and Peer Review programs that assist our clients in ...

HHC

UTILIZATION REVIEW SPECIALIST

Indianapolis, IN · On-site

... assist in problem-solving. Essential Functions and Responsibilities Proactively contributes to ... Utilization Review nurses' team to ensure timely patient progression through the episode/plan of ...

ICBD

Utilization Review Manager

Lauderdale Lakes, FL · On-site

Utilization Review Manager Exact Billing Solutions Lauderdale Lakes, FL (Full-Time/ On-site) Who We ... issues, and assist the team with resolution strategies, challenging negotiations, and cross ...

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How much do utilization review assistant jobs pay per hour?

As of May 30, 2026, the average hourly pay for utilization review assistant in the United States is $30.95, according to ZipRecruiter salary data. Most workers in this role earn between $17.55 and $37.98 per hour, depending on experience, location, and employer.

What is a Utilization Review Assistant job?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What are the key skills and qualifications needed to thrive in the Utilization Review Assistant position, and why are they important?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

What does a typical day look like for a Utilization Review Assistant and who do they work with?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.
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Utilization Review Assistant jobs near you
Infographic showing various Utilization Review Assistant job openings in the United States as of May 2026, with employment types broken down into 67% Full Time, and 33% Part Time. Highlights an 100% In-person job distribution, with an average salary of $64,366 per year, or $30.9 per hour.
Nurse Utilization Review

Nurse Utilization Review

Midland Health

Midland, TX • On-site

Full-time

Medical

Posted 15 days ago

Job description

Job Description
The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care services. Through regular utilization reviews and audits, the UR nurse ensures that patients receive the care they need without unnecessary diagnostic procedures, ineffective treatments or extended hospital stays. The utilization review examines how health care services are being utilized. The UR nurse requires extensive knowledge of patient care, medical treatments and hospital procedures. The UR nurse will rely on their clinical judgment, honed over years in acute care settings, to make responsible decisions that promote patient health and well-being while keeping resources available to those most in need. The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping patients make informed decisions about their health care by educating them on the benefits and limitations of their Medicare, Medicaid or private health care coverage.
SHIFT AND SCHEDULE
Full Time, Monday - Friday; 8:00 AM - 5:00 PM
ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS
• Able to utilize electronic healthcare record (EHR) and billing systems, filter and prioritize UM Worklist, document Utilization Management (UM) reviews of various types, enter notes, locate insurance information, provide clinical updates to 3rd Party payors, place accounts on hold and release, and manage concurrent denials.
• Proficiently navigate within the EHR and the UM platform to gather documented information concerning the patient to establish appropriate utilization of hospital services.
• Conducts and documents an UM Review at time of admission or the next working day.
• Conducts and documents concurrent UM reviews no more than 3 days after admission review has been completed. Refers to Physican Advisor appropriately.
• Performs an in-depth Extended Stay review on patients with a stay greater than 5 days and refers to Physician Advisor appropriately.
• Utilizes and applies UM platform Care Level Scores along with clinical expertise, to validate medical necessity of the ordered admission status, appropriateness of treatment, and ordered level of care.
• Confers with attending physician or Physician Advisor when appropriate to make a determination about medical necessity.
• Communicates and works closely with insurance companies to ensure that the organization will be reimbursed for services rendered. Providing supporting documentation to justify medical necessity of the admission or continuation of stay.
• Assists and educates Medical Staff and other members of the healthcare team with regards to utilization issues such as, but not limited to:
Admission Status
Level of Care
Medical Necessity
Costs and best practices of treatment
Expected Length of Stay (LOS)
• Functions as a resource to the healthcare team regarding approved criteria, practice guidelines, and alternative treatment options.
• Provides monthly reporting to the Utilization Management/Case Management Committee regarding inappropriate admissions.
• Assists with ensuring compliance with CMS Conditions of Participation for Utilization Review, Appendix A/§42 CFR 482.30
EDUCATION AND EXPERIENCE
Current State of Texas License as a Registered Nurse.
5 years of nursing experience (preferably in utilization management or hospital/acute care).
Computer proficiency in Microsoft Office
PHYSICAL REQUIREMENTS
• To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to: Ø Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.

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