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Utilization Review Clinician Jobs (NOW HIRING)

UHS

Utilization Review Clinician

Augusta, GA

Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...

TaraVista

Utilization Review Clinician

Devens, MA · On-site

Join us as a Utilization Review Clinician! Schedule: Monday - Friday, 40 hours onsite. As a Utilization Review Clinician for MiraVista in Holyoke, Massachusetts, you'll bring your experience and ...

UHS

Utilization Review Clinician

Augusta, GA · On-site

Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...

UHS

Utilization Review Clinician

Augusta, GA

Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...

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Utilization Review Clinician information

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How much do utilization review clinician jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for utilization review clinician in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is the difference between Utilization Review Clinician vs Utilization Review Nurse?

AspectUtilization Review ClinicianUtilization Review Nurse
CredentialsTypically requires a healthcare-related degree (e.g., RN, LPN, or other clinical background)Registered Nurse (RN) license is usually required
Work EnvironmentOffice-based, telehealth, or remote settings within insurance companies or healthcare organizationsSimilar settings, often with direct patient or provider interaction
Employer & Industry UsageCommonly employed by insurance companies, third-party administrators, and healthcare organizationsPrimarily employed by insurance companies, hospitals, or healthcare organizations

Both roles involve reviewing medical necessity and determining coverage, often requiring clinical credentials. The main difference lies in job titles and specific responsibilities, but they share similar work environments and industry usage.

How does a Utilization Review Clinician typically collaborate with physicians and insurance providers during the review process?

A Utilization Review Clinician regularly communicates with physicians to gather necessary clinical information and clarify treatment plans, ensuring that all care meets established medical necessity criteria. They also interact with insurance providers to justify the need for specific services or lengths of stay, often providing case summaries and supporting documentation. This collaborative approach helps prevent unnecessary denials and promotes timely authorizations, while also requiring strong communication and negotiation skills.

What are Utilization Review Clinicians?

Utilization Review Clinicians are healthcare professionals who evaluate the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review clinical documentation, patient records, and treatment plans to ensure services meet established guidelines and are covered by insurance. Their work helps control healthcare costs, improve quality of care, and ensure compliance with regulations. Utilization Review Clinicians often collaborate with physicians, insurance companies, and case managers to facilitate optimal patient outcomes.

What are the key skills and qualifications needed to thrive as a Utilization Review Clinician, and why are they important?

To thrive as a Utilization Review Clinician, you need a solid clinical background—often as a licensed RN, LCSW, or similar—along with expertise in medical necessity criteria and care coordination. Familiarity with utilization management software, electronic health records (EHRs), and guidelines such as InterQual or MCG is typically required. Strong analytical skills, attention to detail, and effective communication are essential soft skills for collaborating with healthcare providers and payers. These abilities ensure accurate, timely reviews that support patient care while managing healthcare resources efficiently.
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What cities are hiring for Utilization Review Clinician jobs? Cities with the most Utilization Review Clinician job openings:
What states have the most Utilization Review Clinician jobs? States with the most job openings for Utilization Review Clinician jobs include:
What job categories do people searching Utilization Review Clinician jobs look for? The top searched job categories for Utilization Review Clinician jobs are:
Utilization Review Clinician jobs near you
Infographic showing various Utilization Review Clinician job openings in the United States as of July 2026, with employment types broken down into 1% Locum Tenens, 3% As Needed, 60% Full Time, 18% Part Time, and 18% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Clinician

Utilization Review Clinician

Monte Nido & Affiliates, LLC

Remote

$70K - $85K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Job description

Grow with us!
Utilization Review Clinician
Monte Nido
Remote - MST/CST hours
Monte Nido has been delivering treatment for eating disorders for over two decades. Our programs offer a model of treatment that blends medically sophisticated care with a personalized treatment approach. Our work is grounded in evidence-based strategies for adults and adolescents suffering from eating disorders. We work from a multi-disciplinary treatment team approach while integrating state-of-the-art medical, psychiatric, nutritional, and clinical strategies to provide comprehensive care within an intimate home setting.
We are seeking a Utilization Review Clinician to join our team either on site in Miami or based Remotely
The Utilization Review Clinician is responsible for conducting all utilization reviews, peer reviews, and pre-certifications in a well formulated and comprehensive manner, documenting these reviews, and coordinating with both the on-site clinical team, admissions, verifications, and billing regarding clients' insurance status.
Pay: $70,000.00-$85,000.00 (depending on education and experience)
#LI-REMOTE
Total Rewards:
Discover a rewarding career with us and enjoy an array of comprehensive benefits! We prioritize your success and well-being, providing:
  • Competitive compensation
  • Medical, dental, and vision insurance coverage (Benefits At a Glance)
  • Retirement
  • Company-paid life insurance, AD&D, and short-term disability
  • Employee Assistance Program (EAP)
  • Flexible Spending Account (FSA)
  • Health Savings Account (HSA)
  • Paid time off
  • Professional development
  • And many more!

We are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Responsibilities Include:
  • Complete and manage all authorizations for designated programs & departments including prior authorization, continued stay, change in level of care, discharge, retrospective, facilitating peer to peer reviews, and written appeals.
  • Engage in clinical rounds as an active treatment team member providing payor feedback and needs for next review, guidance on level of care recommendations, and feedback on what will be needed for authorization of clinically indicated services.
  • Support treatment team members & Admissions by discussing services covered by the members benefits and reviewing clinical documentation needed to advocate with our client's insurance most successfully.
  • Communicate with billing regarding billing/claims issues and status of single case agreements as needed.
  • Effectively communicate with program leadership, clinicians, and admissions regarding status of client authorization, potential denials, and potential for private payment.
  • Follow workflow and medical record requirements for utilization review and clinical documentation across programs.
  • Leverage understanding of medical necessity criteria and current behavioral health insurance landscape in verbal and written communications with payors to maximize our clients' access to care and decrease peer to peer reviews.
  • Communicate emerging trends with insurance companies to Director of Utilization Management.
  • Maintain database of insurance company clinical care guidelines, APA guidelines, medical necessity criteria and other necessary documents and clinical ammunition to support UR process.
  • Deliver care in a non-judgmental and non-discriminatory manner, sensitive to patient and staff diversity.
  • Seek corrective criticism and evaluate suggestions objectively.
  • Maintain acceptable overall attendance.
  • Promote a favorable/positive work atmosphere.
  • Attend in-services and educational training as necessary and as assigned.
  • Seek out learning experiences and incorporate new knowledge into practice.
  • Maintain flexibility and adaptability to expected and unexpected changes in the work environment.
  • Report incidents, accidents, and occurrences in accordance with policies and procedures.
  • Maintain safety of the physical environment.
  • Comply with facility policies and procedures.

Qualifications:
  • Master's Degree in Psychology, Social Work, Nutrition, or mental health-related field required
  • At least one year of experience relating to insurance authorizations and managed care.
  • Experience providing direct care to individuals with an eating disorder preferred.
  • Licensed behavioral health clinician/provider or RD

#montenido

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