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Utilization Review Clinician Jobs (NOW HIRING)

MiraVista

Utilization Review Clinician

Holyoke, MA

Join us as a Utilization Review Clinician! Schedule: Monday - Friday, 40 hours, onsite 5 days a week. As a Utilization Review Clinician for MiraVista in Holyoke, Massachusetts, you'll bring your ...

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

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 · 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 ...

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 ...

Centene

Utilization Review Clinician - ABA

$27.02 - $48.55/hr

We are seeking a Utilization Review Clinician - ABA to join our team! The ideal candidate will bring expertise in: * BCBA Certificate * ABA Treatment Experience * Technological Savvy * Excellent ...

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How much do utilization review clinician jobs pay per hour?

As of Aug 24, 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.

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States with the most job openings for Utilization Review Clinician jobs include:

What job categories do people searching Utilization Review Clinician jobs look for?

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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 83% Full Time, and 17% Contract. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Clinician

Holyoke, MA • On-site

TaraVista Behavioral Health
See more jobs at TaraVista Behavioral Healthexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

Job description

Join us as a Utilization Review Clinician!

Schedule: Monday - Friday, 40 hours, onsite 5 days a week.

As a Utilization Review Clinician for MiraVista in Holyoke, Massachusetts, youll bring your experience and knowledge where your voice matters. A Utilization Review Clinician is an integral part of our multidisciplinary team.

As a Utilization Review Clinician:

  • You will be an active participant in the health care team.

  • You are responsible for pre-certification, concurrent and discharge reviews, appeals and denials, and the compliance of contracted quality measures identified by managed care organizations.

  • You will serve as liaison between the hospital and outside payor sources in accordance with the mission and core principals of MiraVista Behavioral Health Center.

The Utilization Review Clinician will have the following:

  • Master's level clinician or RN.

  • Previous utilization management, preferably in an inpatient psychiatric setting

  • License eligible (LMHC or LICSW preferred) or RN

  • Possess sufficient knowledge regarding clinical treatment of psychiatric patients, the mental health care delivery system, and the managed care environment

  • Display excellent communication skills and an ability to integrate clinical and financial information in the context of an overall utilization management program

  • Requires the ability to work in a multidisciplinary, fast paced environment with a demonstrated sense of autonomy and professionalism.

When you join the growing MiraVista team as a Utilization Review Clinician, youll receive:

  • Medical, Dental, and Vision

  • 401(k) match

  • Employer paid long term disability (LTD)

  • Short term disability (STD)

  • Employer paid life and AD&D Insurance

  • Generous Paid Time Off

  • Flexible Spending Account

  • Tuition Reimbursement

Pay Range:

Compensation will be determined based on the candidate's relevant experience.

$80,000 - $90,000

MiraVista is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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