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Utilization Review Coordinator Jobs (NOW HIRING)

Franciscan Health

Utilization Review Coordinator

Work From Home Work From Home Work From Home, Indiana 46544 The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for ...

UHS

Utilization Review Coordinator

Champaign, IL · On-site

$61K - $71K/yr

Responsibilities Full-time Utilization Review Coordinator Opening The Pavilion Behavioral Health System has been the leading provider of behavioral health and addictions treatment for families in ...

Axiom Care

Utilization Review Coordinator

Phoenix, AZ · On-site

Job Type Full-time Description The UR Coordinator's primary responsibility is managing, reviewing, and monitoring utilization of patient resources and obtaining payor authorization as required for ...

UHS

Utilization Review Coordinator

Champaign, IL

Responsibilities Full-time Utilization Review Coordinator Opening The Pavilion Behavioral Health System has been the leading provider of behavioral health and addictions treatment for families in ...

UHS

Utilization Review Coordinator

West Columbia, SC

Coordinates the utilization management functions of a patient caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations ...

UHS

Utilization Review Coordinator

West Columbia, SC

Coordinates the utilization management functions of a patient caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations ...

UHS

Utilization Review Coordinator

West Columbia, SC · On-site

Coordinates the utilization management functions of a patient caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations ...

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How much do utilization review coordinator jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for utilization review coordinator in the United States is $29.61, according to ZipRecruiter salary data. Most workers in this role earn between $21.39 and $34.62 per hour, depending on experience, location, and employer.

How does a utilization review coordinator collaborate with healthcare providers and insurance companies?

A Utilization Review Coordinator regularly communicates with both healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. They review medical records and treatment plans, discuss cases with physicians to clarify medical necessity, and submit documentation to insurance payers for approval. This role requires strong interpersonal skills, as coordinators often need to negotiate coverage decisions and resolve discrepancies between clinical teams and insurers. Effective collaboration ensures timely authorizations and helps avoid unnecessary delays in patient care.

What degree do I need for utilization review coordinator?

A utilization review coordinator typically needs at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Relevant certifications, such as Certified Professional Coder (CPC) or Certified Utilization Review Professional (CURP), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and healthcare regulations is also important.

What does a utilization review coordinator do?

A Utilization Review Coordinator is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance information to ensure that care meets established guidelines and regulatory requirements. By coordinating between healthcare providers, insurance companies, and patients, Utilization Review Coordinators help optimize resource use and manage healthcare costs while ensuring quality patient care.

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

AspectUtilization Review CoordinatorUtilization Review Nurse
CredentialsTypically requires a healthcare-related certification or associate degreeRegistered Nurse (RN) license required
Work EnvironmentOffice setting, administrative tasks, coordinationClinical setting, patient chart review, direct communication with healthcare providers
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Common Search & ComparisonFocuses on administrative review processesInvolves clinical assessment and patient care considerations

While both roles involve reviewing healthcare utilization, the Utilization Review Coordinator primarily handles administrative and coordination tasks, often without direct patient contact, whereas the Utilization Review Nurse performs clinical assessments as a licensed RN, often in hospital or clinical settings. Understanding these differences helps job seekers identify the right role based on their credentials and career goals.

What skills and qualifications are needed to be a utilization review coordinator?

To thrive as a Utilization Review Coordinator, you need expertise in healthcare regulations, clinical guidelines, and case management, often supported by an RN license or a background in health administration. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance approval processes are typically required. Strong analytical thinking, attention to detail, and effective communication skills help you collaborate with providers and advocate for appropriate patient care. These skills ensure compliance, optimize resource use, and support quality care delivery within healthcare organizations.
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Utilization Review Coordinator jobs near you
Infographic showing various Utilization Review Coordinator job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $61,585 per year, or $29.6 per hour.

Utilization Review Coordinator

Port St. Lucie Hospital

Port Saint Lucie, FL

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted yesterday

Job description

Utilization Review Coordinator

Location: Everwell Port St. Lucie Hospital, Inc

Position Summary

Everwell Port St. Lucie Hospital is seeking a detail-oriented Utilization Review Coordinator to coordinate insurance reviews, monitor patient authorizations, and support effective communication between the hospital, physicians, and insurance providers.

Key Responsibilities

  • Review all patients’ admissions on a daily basis to determine necessity and appropriateness of placement services as outlined in Plans and Procedures.

  • Assigns continued stay reviews according to criteria; reviews continued stay at least every ten (10) to fourteen (14) days and certified pursuant to approved criteria.

  • Maintains a system for monitoring all admissions to assure timely reviews; collects and records all necessary information/data for review of admission, continued stay, and utilization of services.

  • Reviews patient records upon request of insurance companies and communicates patient condition and treatment to external utilization review offices.

  • Contacts physicians and primary Nurses for clarification of information as necessary.

  • Assures appropriate Authorization of Release of Information forms are obtained prior to releasing information to insurance companies.

  • Completes mental health treatment reports and other reports, including appeal letters, required by insurance companies for review of patient care and treatment as requested.

  • Monitors information that is copied and sent per request to insurance companies for inpatient and assures that only required information is disseminated.

  • Contacts physicians, primary Nurses and other appropriate staff regarding potential problems or questions related to documentation of patient care issues.

  • Coordinates and schedules all PRO reconsideration hearings and schedules appropriate staff to attend hearings.

  • Coordinates the assemblage of records for review by Federal State, Professional and appropriate hospital groups.

  • Performs special projects or other related work as required or requested.

  • Shows ability to communicate in a clear and concise manner.                       

  • Demonstrates ability to work with others.

  • Adapt to changing situations or work assignments.

  • Demonstrates willingness to rotate to other areas of hospital within the limits of preparation and skill level.

  • Conform to uniform and dress code, personal hygiene and good grooming.

  • Wear and properly display name badge.                                                                 

  • Positively respond to guidance or counseling and attempts to benefit by it.

  • Adept in identifying potential problems within the department and seeks management guidance.

  • Demonstrates excellent organizational skills and originator of new ideas and methods.

  • Use verbal and non-verbal communication with others, i.e., courtesy, tone of voice, facial expressions, gestures, etc.

  • Demonstrates an understanding of and adherence to the Code of Conduct

  • Conduct reflects Oglethorpe’s values and a commitment to the Code of Conduct

Qualifications and Education

  • RN, LPN or Master's Level Clinician with experience

  • CPR Certification required

  • Minimum 2 years of healthcare experience preferred

  • Knowledge of utilization review processes and medical terminology

  • Experience working with insurance companies and behavioral health

    documentation preferred

  • Ability to use data collection techniques, and statistical computations.

  • Strong communication, organizational, and analytical skills

  • Familiarity with DSM criteria and healthcare compliance standards preferred

  • Thorough knowledge of effective and appropriate charting principles

    Work Environment

    • Primarily indoor, temperature-controlled healthcare environment

    • Collaborative team-focused setting

      Benefits

    • Medical, Dental and Vision insurance

    • 401K

    • PTO and Sick time

    This position requires a pre-employment Level 2 Background check: https://info.flclearinghouse.com