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Utilization Review Job Jobs (NOW HIRING)

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K Who We Are Exact Billing Solutions is a unique team of revenue cycle ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K Who We Are Exact Billing Solutions is a unique team of revenue cycle ...

UHS

Utilization Review Coordinator

Augusta, GA

The Utilization Review Coordinator 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 ...

PARKSIDE INC

Utilization Review Specialist

Tulsa, OK · On-site

The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private ...

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How much do utilization review job jobs pay per hour?

As of Jul 7, 2026, the average hourly pay for utilization review job 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 Job vs Case Manager?

AspectUtilization Review JobCase Manager
CredentialsOften requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalTypically requires social work, nursing, or healthcare-related certifications, such as LCSW or RN
Work EnvironmentHospitals, insurance companies, healthcare facilities, or managed care organizationsHospitals, community health agencies, insurance companies, or social service organizations
Employer & Industry UsageUsed in insurance, healthcare, and managed care to evaluate medical necessityUsed in healthcare, social services, and insurance to coordinate patient care and support services

While both roles involve healthcare assessment, Utilization Review Jobs focus on evaluating the necessity of medical services, often within insurance or managed care settings. Case Managers, on the other hand, coordinate patient care and support services, addressing broader patient needs. Both roles require healthcare credentials and work in similar environments, but their primary functions differ in scope and responsibilities.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on individual workload, work environment, and experience. Strong organizational skills and knowledge of healthcare policies can help manage job-related stress.

What jobs pay 4000 a week without a degree?

In utilization review roles, such as senior or experienced reviewers, it is possible to earn around $4,000 weekly, especially with extensive experience, certifications, or working in high-demand healthcare settings. These positions often require strong analytical skills, knowledge of medical terminology, and familiarity with healthcare policies, but they typically do not require a college degree.

What does a utilization reviewer do?

A utilization reviewer's role involves evaluating medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure that care complies with insurance policies and industry standards, often using healthcare management software and requiring knowledge of medical guidelines. This process helps control costs and supports quality patient care.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a healthcare-related degree such as nursing, health administration, or a related field. Relevant experience in clinical settings or insurance is often required, along with knowledge of medical coding and utilization review processes; some employers may also require certification such as the Certified Professional in Healthcare Quality (CPHQ).
What cities are hiring for Utilization Review Job jobs? Cities with the most Utilization Review Job job openings:
What states have the most Utilization Review Job jobs? States with the most job openings for Utilization Review Job jobs include:
Utilization Review Job jobs near you
Utilization Review Specialist

Utilization Review Specialist

ELEMENT MEDICAL BILLING LLC

Port Saint Lucie, FL • On-site

Full-time

Posted 11 days ago

Job description

Job Summary

We are seeking a highly motivated and detail-oriented Utilization Reviewer to join our dynamic healthcare team. In this pivotal role, you will evaluate medical records, clinical documentation, and patient care plans to ensure appropriate utilization of healthcare services. Your expertise will support clinical decision-making, promote compliance with regulatory standards, and optimize patient outcomes. The ideal candidate will possess a strong foundation in medical terminology, coding, and utilization management processes, with a passion for improving healthcare efficiency and quality.

Duties

Review medical documentation, including clinical notes, discharge summaries, and treatment plans to assess medical necessity and appropriateness of services.

Utilize advanced electronic health record (EHR) systems such as Epic, Cerner, Athenahealth, or eClinicalWorks to access and analyze patient information efficiently.

Apply knowledge of CPT coding, ICD-9/10 coding systems, DRGs (Diagnosis-Related Groups), and MDS (Minimum Data Set) to accurately classify diagnoses and procedures.

Conduct utilization reviews for inpatient and outpatient services across various settings including acute care hospitals, nursing homes, hospice care, emergency departments, PICUs (Pediatric Intensive Care Units), and Level I/II trauma centers.

Collaborate with multidisciplinary teams to facilitate discharge planning, case management, and clinical documentation improvement initiatives aligned with NCQA standards.

Ensure compliance with HIPAA regulations while handling sensitive patient information and medical records.

Participate in ongoing education related to managed care policies, Medicare/Medicaid guidelines, and evolving healthcare regulations to maintain current knowledge.

Experience

Proven experience in utilization review or utilization management within hospital or managed care environments.

Strong background in clinical settings such as ICU, emergency medicine, primary care, pediatrics, or nursing homes.

Familiarity with EMR/EHR systems like Epic, Cerner, Athenahealth or eClinicalWorks is essential for efficient workflow.

In-depth understanding of medical coding including CPT, ICD-9/10 codes, DRGs, and case management documentation standards.

Critical care experience or ICU background is highly desirable for assessing complex cases accurately.

Knowledge of Medicare regulations and NCQA standards to ensure compliance during reviews.

Excellent analytical skills combined with a thorough understanding of anatomy physiology and medical terminology to interpret complex clinical data effectively. Join us in making a meaningful impact on patient care by ensuring the appropriate use of healthcare resources! We are committed to fostering an inclusive environment that supports your professional growth while promoting work-life balance through comprehensive benefits designed to support your overall well-being.

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