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Utilization Review Job Jobs (NOW HIRING)

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

UHS

Utilization Review Coordinator

Augusta, GA · On-site

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 ...

Seh

The Utilization Review case manager collaborates with all components of the healthcare system, managing appropriate use of acute care to aid in the achievement of quality outcomes, fiscal ...

Southeast Health

Utilization Review Nurse

Dothan, AL · On-site

The Utilization Review case manager collaborates with all components of the healthcare system, managing appropriate use of acute care to aid in the achievement of quality outcomes, fiscal ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level) * Independent external reviews * DRG validation and clinical review * Benefit and coverage ...

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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 COORDINATOR

UTILIZATION REVIEW COORDINATOR

MOUNTAIN VIEW HOSPITAL LLC

Idaho Falls, ID • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 9 days ago

Mountain View Hospital (Idaho Falls) rating

5.4

Company rating: 5.4 out of 10

Based on 58 frontline employees who took The Breakroom Quiz

907th of 1,004 rated hospitals

Job description

Mountain View Hospital is looking for a Utilization Review Coordinator to join our team!

JOB SUMMARY: As a member of the Utilization Management Team, the UR
Coordinator helps establish and maintain efficient methods of ensuring the medical necessity and appropriateness of hospital admissions and extended stays. The Utilization Management Team directs the program in accordance with Mountain View Hospital’s mission and strategic goals. The Utilization Management Team directs those activities within the facility which monitor adherence to the hospital’s utilization review plan. The goal of Utilization Management is to continuously improve effective use of hospital services through monitoring patient admissions and stays.

About Mountain View:

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.

Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.

BENEFITS:

Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:

  • Medical, Dental and Vision Insurance
  • Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
  • Retirement Plans (401K with up to 6% match)
  • Earned Quarterly Bonus Program
  • Education Reimbursement Program
  • Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.

Education/Certification: High School Diploma or equivalent. Coding certificate completion is required within 1 year of employment

Experience: Background in medical terminology is helpful. Medical coding and/or insurance experience preferred, however coding certification will be required with in one calendar year of employment

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