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Utilization Review Clinician Jobs (NOW HIRING)

Gaudenzia

Clinical Review Clinician

Washington, DC · On-site

$85K/yr

We are seeking master's level, licensed, clinician, with documented experience in utilization review, management, and quality assurance skills! Are you ready and willing to make a difference and ...

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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.

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What states have the most Utilization Review Clinician jobs?

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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 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.

Clinical Coordinator - Utilization Review

Hampton-Newport News Community Services Board

Hampton, VA • On-site

$62K - $66K/yr

Full-time

Dental, Vision, Life, Retirement

Re-posted 7 days ago

Job description

Clinical Coordinator - Utilization ReviewAnnual Salary: $62,406 - $66,000Work Schedule: Monday - Friday 8:30 am - 5:00 pmThe Hampton-Newport News Community Services Board (CSB) is seeking a Clinical Coordinator - Utilization Review to join the Region 5 Reinvestment Initiative. This full-time position plays an important role in ensuring individuals receive timely, appropriate, and effective behavioral health services while supporting regional efforts to improve access to care and coordinate treatment placements.The Clinical Coordinator - Utilization Review conducts utilization reviews of acute and intermediate levels of care, evaluates medical necessity and appropriateness of services, and manages behavioral health bed utilization on a daily basis. This position works closely with hospitals, treatment facilities, CSB staff, and regional partners to support timely movement to the most appropriate level of care.Minimum QualificationsTo qualify for this position, candidates must have:Master's degree in Human Services or a related field.Three (3) years of experience in behavioral health, including utilization management.Key ResponsibilitiesConduct utilization reviews of acute and intermediate levels of care to assess medical necessity, appropriateness of treatment, and continued stay criteria.Manage and monitor acute care bed availability and placements to support timely and appropriate transitions in care.Conduct face-to-face assessments and gather information regarding an individual's treatment needs, progress, and current level of functioning.Review treatment progress and outcomes and make recommendations regarding the most appropriate level of care.Coordinate communication among hospitals, facilities, CSB staff, and regional partners regarding admissions, continued stays, discharges, and placements.Provide guidance and recommendations related to acute, sub-acute, crisis stabilization, and community-based services.Monitor consumer placements and assist with identifying appropriate and least restrictive treatment options.Communicate findings, recommendations, and utilization concerns to appropriate stakeholders.Prepare utilization reports and provide data-driven recommendations to support regional behavioral health planning and resource management.Promote quality, cost-effective care while supporting timely access to appropriate services.Participate in regional initiatives and activities designed to improve behavioral health system coordination and outcomes.BENEFITSHealth, Vision, and Dental InsuranceVirginia Retirement SystemFlexible Spending Account (FSA)Life Insurance11 Paid Holidays The selected candidate must successfully pass a criminal history fingerprint background investigation, DMV record check, Child Registry search, drug screening test and employment reference checks.
Job Posted by ApplicantPro