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Utilization Review Lcsw Jobs (NOW HIRING)

GRO Community

Utilization Review Manager

Chicago, IL · On-site

Utilization Review Manager Location: Chicago Job Type: Full-Time Reports to: Director of Revenue ... Active LCSW or LCPC clinical licensure highly preferred. Skills: * Strong knowledge of insurance ...

GRO Community

Utilization Review Manager

Chicago, IL

Utilization Review Manager Location: Chicago Job Type: Full-Time Reports to: Director of Revenue ... Active LCSW or LCPC clinical licensure highly preferred. Skills: * Strong knowledge of insurance ...

UHS

Director, Utilization Review (UR)

Orem, UT

Valid Utah RN license or license authorized to practice in Utah OR Valid Utah LMSW/LCSW license * Experience: Requires (3-5) years of experience working in utilization review preferrably in a psych ...

NHC HomeCare

Masters Social Worker

Antioch, TN · On-site

Current license as Licensed Clinical Social Worker (LCSW) SOUTH CAROLINA * Current state licensure ... Serves as Utilization Review and/or Advisory Board Member as requested by Administrator/Director of ...

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Utilization Review Lcsw information

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How much do utilization review lcsw jobs pay per hour?

As of Jul 5, 2026, the average hourly pay for utilization review lcsw in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.

What is the difference between Utilization Review Lcsw vs Medical Social Worker?

AspectUtilization Review LcswMedical Social Worker
CredentialsLicensed Clinical Social Worker (LCSW), certification in utilization review often preferredLicensed Clinical Social Worker (LCSW), with clinical social work experience in healthcare
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, clinics, patient homes, healthcare settings
Primary FocusReviewing medical necessity, insurance approvals, and utilization managementProviding psychosocial support, discharge planning, and patient advocacy

The Utilization Review Lcsw primarily focuses on insurance review and utilization management within healthcare settings, requiring knowledge of medical necessity criteria. In contrast, Medical Social Workers provide direct patient support, counseling, and discharge planning. While both roles require an LCSW license, their daily responsibilities and work environments differ significantly.

What are the key skills and qualifications needed to thrive as a Utilization Review LCSW, and why are they important?

To thrive as a Utilization Review LCSW, you need a master's degree in social work (MSW), LCSW licensure, and a strong understanding of clinical assessment and care coordination. Familiarity with medical necessity criteria, insurance guidelines, and electronic health record (EHR) systems is essential, and certification in case management or utilization review is often preferred. Exceptional analytical skills, attention to detail, and clear communication help you advocate effectively for patients and collaborate with healthcare teams. These competencies ensure appropriate care, cost-effectiveness, and compliance with regulatory standards in healthcare delivery.

What are the main challenges Utilization Review LCSWs face when balancing clinical judgment and insurance guidelines?

Utilization Review LCSWs often encounter the challenge of aligning their clinical assessments with insurance coverage criteria, which can sometimes restrict recommended care options. Navigating these situations requires strong communication skills to advocate for appropriate patient care while adhering to payer policies. Frequent collaboration with healthcare providers and insurance representatives is essential to ensure patients receive necessary services without unnecessary delays. This balancing act can be demanding but is also highly rewarding for those who value systemic impact and patient advocacy.

What is a Utilization Review LCSW?

A Utilization Review LCSW (Licensed Clinical Social Worker) is a mental health professional who evaluates the medical necessity, appropriateness, and efficiency of mental health services for patients. They review clinical documentation to ensure that treatments meet insurance and regulatory guidelines, often acting as a liaison between healthcare providers and payers. Their goal is to ensure patients receive necessary care while also reducing unnecessary costs and maintaining compliance with healthcare policies.
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Utilization Review Lcsw jobs near you
Infographic showing various Utilization Review Lcsw job openings in the United States as of June 2026, with employment types broken down into 97% Full Time, 2% Part Time, and 1% Temporary. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.

Utilization Review Manager

GRO Community

Chicago, IL • On-site

Full-time

Posted 6 days ago

Job description

Job Title: Utilization Review Manager
Location: Chicago Job Type: Full-Time
Reports to: Director of Revenue Cycle Manager; In Direct Reporting to Chief Clinical Officer
Direct Reports: none, subject to change in future
About Us:
God Restoring Order (GRO) Community is a mental healthcare provider that specializes in trauma recovery services for males of color ages 5 and up. GRO services are grounded in an understanding of the neurological, biological and psychological effects of trauma. GRO services include mental health and wellness, stress management, and community outreach.
Position Summary:
The Utilization Review Manager (URM) is responsible for coordinating and monitoring clinical documentation and service authorizations to ensure medical necessity, regulatory compliance, and optimal reimbursement. This role serves as a key liaison between clinical staff, payers, and administrative teams to support timely and accurate utilization management while maintaining quality-of-care standards. The URS will also facilitate utilization review processes across departments and coordinate appropriate client step-downs when clinically indicated.
Key Responsibilities:
Utilization Review & Authorization Management
  • Conduct ongoing utilization reviews of client treatment plans, progress notes, and service delivery to ensure alignment with payer and regulatory requirements.
  • Coordinate with insurance companies by submitting all required documentation and addressing any disputes or discrepancies.
  • Submit, track, and follow up on initial and continued service authorization requests with insurance carriers and funding sources. Monitor and analyze denial trends, proactively identifying opportunities to improve documentation and authorization processes. Maintain detailed records of authorization status, denials, and appeal outcomes.

Clinical Documentation Oversight
  • Collaborate with clinicians to ensure treatment plans, assessments, and progress notes meet clinical and payer criteria.
  • Provide guidance and training to staff on documentation standards related to utilization review and medical necessity.
  • Participate in internal audits and assist in developing corrective action plans when deficiencies are identified.

Communication & Coordination
  • Serve as the primary point of contact for payer representatives regarding authorizations, reauthorizations, and claims-related issues.
  • Partner with the revenue cycle team to reconcile service utilization against approved authorizations.
  • Work closely with Clinical Operations and Counseling supervisors to monitor caseload utilization and prevent service gaps or overages.

Compliance & Reporting
  • Ensure adherence to HIPAA, Medicaid, and managed care regulations.
  • Maintain up-to-date knowledge of payer requirements, industry standards, and policy changes affecting utilization management.
  • Prepare and present utilization and authorization reports to leadership, identifying patterns and recommendations for improvement.

Competencies:
  • Regulatory & Compliance Knowledge
  • Critical Thinking & Problem Solving
  • Clinical Documentation Review
  • Communication & Collaboration
  • Time Management & Prioritization
  • Integrity & Confidentiality

Work Setting:
  • Standard office setting.
  • May require occasional travel to clinical sites or payer meetings.

Qualifications:
  • Education: Masters degree in Nursing, Psychology, Social Work, Health Administration, or related field required
  • Experience: Minimum 3-5 years of utilization review, case management, or clinical documentation experience in a healthcare, behavioral health, or managed care environment.
  • Licensure/Certification: Active LCSW or LCPC clinical licensure highly preferred.

Skills:
  • Strong knowledge of insurance authorization processes and payer criteria.
  • Excellent analytical and communication skills.
  • High attention to detail and ability to manage multiple cases simultaneously.
  • Proficiency in EHR systems and Google Office Suite.

What We Offer:
  • Competitive salary and benefits package.
  • A supportive and dynamic work environment committed to social impact.
  • Opportunities for professional development and growth.

How to Apply:
At GRO Community, we believe in healing through empowerment and innovation. Our work centers on serving individuals and families with compassion and integrity. Join our team to make a meaningful impact while building your professional skills in a supportive and mission-driven environment.
Interested candidates should submit a resume and cover letter detailing their relevant experience to grosources@grocommunity.org.

Apply