ZipRecruiter

Log In

1

Utilization Review Clinician Jobs (NOW HIRING)

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 ...

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 ...

Umpqua Health

Utilization Review Clinician

UTILIZATION REVIEW CLINICIAN REMOTE Ability to travel on-site to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as needed for business operations EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Clinician

Roseburg, OR · On-site +1

$80K - $94K/yr

UTILIZATION REVIEW CLINICIAN REMOTE Ability to travel on-site to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as needed for business operations EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Clinician

Roseburg, OR · Remote

$80K - $94K/yr

UTILIZATION REVIEW CLINICIAN REMOTE Ability to travel on-site to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as needed for business operations EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Review clinical documentation and determine benefit eligibility using evidence-based clinical ... Ensure all utilization review activities meet regulatory turnaround time requirements.

next page

Showing results 1-20

All JobsHealthcare JobsNursing JobsNurse Case Manager JobsUtilization Review Clinician Jobs

Utilization Review Clinician information

See salary details

$21

$42

$68

How much do utilization review clinician jobs pay per hour?

As of Aug 19, 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 a utilization review clinician?

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.

How does a utilization review clinician 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 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.

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.

More about Utilization Review Clinician jobs

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 August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Clinician

Alan B. Miller Medical Center

Augusta, GA • On-site

Other

Medical, Dental, Vision, Retirement, PTO

Posted 15 days ago

Job description

Utilization Review Clinician Opportunity

Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15 years. Located in Augusta, GA, our 84-bed facility provides a therapeutic setting for those seeking treatment for mental illness. Lighthouse Care Center offers unique and individualized programming for adolescents and adults that sets us apart from many other treatment facilities, and our tenured team includes seasoned medical staff.

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; ensuring that delivery of high-quality and cost-effective treatment is consistent with the mission, vision, and values of Universal Health Services and in accordance with government regulation, licensing, and accreditation requirements. Under the direction of the UR Manager, the Utilization Review Coordinator is responsible for conducting clinical review of data to determine eligibility respective to pre-certification and continued stay reviews.

Job duties/responsibilities include reviewing clinical content of medical records, participating in treatment team meetings, and collaborating with physicians, therapists, nurses, and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved. Ensure input of pre-certifications and continued stay reviews into Midas, follow-up on unfinished pre-certifications from the day before, coordinate with the treatment team on any follow-ups necessary, verify insurance coverage at the first of the month, and post patient payments into MS4. Trained in all aspects relative to timely gathering of clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer-based systems, in addition to other job duties.

Benefit highlights include a referral bonus program, challenging and rewarding work environment, competitive compensation & generous paid time off, excellent medical, dental, vision, and prescription drug plans, 401(k) with company match and discounted stock plan, and career development opportunities within UHS and its 300+ subsidiaries!

Apply