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Utilization Review Management Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Collaborate with physicians, case management, and care teams * Support discharge planning and care ...

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly ...

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly ...

UF Health

Manager, Utilization Review

Gainesville, FL · On-site

Overview The Manager of Utilization Review provides operational leadership and oversight for ... Minimum five (5) years of Utilization Management, Case Management, Revenue Cycle, or Denials ...

Acrisure

Utilization Review Nurse

Bradenton, FL

Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly ...

UF Health

Manager, Utilization Review

Gainesville, FL · On-site

Overview The Manager of Utilization Review provides operational leadership and oversight for ... Minimum five (5) years of Utilization Management, Case Management, Revenue Cycle, or Denials ...

UHS

PR · On-site

The Utilization Review (UR) Director is responsible for overseeing the utilization management ... Manage and supervise the UR team, setting standards for reviewing mental health services to ensure ...

Acrisure, LLC

Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly ...

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Utilization Review Management information

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How much do utilization review management jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for utilization review management 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 utilization review management?

Utilization Review Management is a process used in healthcare to evaluate the necessity, appropriateness, and efficiency of medical services, procedures, and facilities. Its primary goal is to ensure that patients receive appropriate care while preventing unnecessary or duplicative services. Utilization Review Management helps healthcare providers and insurance companies manage costs, maintain high-quality care, and comply with regulations. Professionals in this field often review patient records, coordinate with clinicians, and make recommendations about coverage or care plans.

What are the key skills and qualifications needed to thrive in utilization review management?

To thrive in Utilization Review Management, you need a solid background in healthcare, strong analytical skills, and often a clinical degree such as RN or LPN, with certification in utilization review or case management being highly beneficial. Familiarity with medical coding systems (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required. Excellent communication, critical thinking, and negotiation skills help you collaborate with providers and payers while advocating for patient care. These competencies are vital for ensuring appropriate resource use, regulatory compliance, and optimal patient outcomes.

What are some common challenges faced by professionals in utilization review management, and how can they be addressed?

Professionals in Utilization Review Management often encounter challenges such as balancing regulatory compliance with patient advocacy and managing high caseloads under tight deadlines. Navigating complex insurance policies and ensuring timely communication between healthcare providers and payers can be demanding. Staying organized, leveraging technology for workflow management, and participating in ongoing training can help address these challenges. Additionally, strong collaboration with interdisciplinary teams ensures more effective and efficient utilization review processes.

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

AspectUtilization Review ManagementUtilization Review Nurse
CredentialsTypically requires a healthcare management or related certification, sometimes a nursing backgroundRegistered Nurse (RN) license, often with additional utilization review certification
Work EnvironmentOffice-based, administrative setting, collaborating with healthcare providers and insurance companiesClinical setting, reviewing patient charts, and making utilization decisions
Employer & IndustryHealth insurance companies, managed care organizations, healthcare administratorsHospitals, insurance companies, healthcare facilities

Utilization Review Management professionals focus on overseeing review processes, policy compliance, and administrative tasks, while Utilization Review Nurses conduct clinical assessments to determine appropriate care. Both roles are essential in healthcare utilization management but differ in responsibilities and work environment.

How do I get into utilization review management?

To enter utilization review management, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of medical billing and coding. Obtaining relevant certifications such as the Certified Professional in Utilization Review (CPUR) or Certified Case Manager (CCM) can improve job prospects, and strong analytical, communication, and organizational skills are essential for success in this role.

How much does a utilization review manager make?

A utilization review manager typically earns between $70,000 and $110,000 annually, depending on experience, location, and the size of the organization. They often require knowledge of healthcare policies, insurance processes, and may hold certifications such as URAC or CCM.
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Utilization Review Management jobs near you
Infographic showing various Utilization Review Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.

Utilization Review Technician

Gadsden, AL • On-site

Riverview Regional Medical Center
See more jobs at Riverview Regional Medical Centerexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted yesterday

Job description

Overview
Department: Social Work Services
Shifts Available: Days
Employment Type: Full Time
Hours: 8-hour shift - 7:30am to 3:30pm
Location: Riverview Regional Medical Center - Gadsden, AL
We are seeking an Utilization Review Technician II, sometimes referred to as Utilization Management Technician II or Utilization Review Coordinator II. The Utilization Review Technician II supports the utilization review, appeals, and denial management process by coordinating communication and tracking payer-related activity. This role works closely with insurance providers, health plans, Utilization Review teams, the Business Office, and Case Managers to help ensure timely follow-up on authorizations, reviews, appeals, and denials. The position also assists with payer audits, Release of Information, discharge coordination, and other departmental needs.
Responsibilities
  • Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews, appeals, and denials
  • Document and track all communication attempts with insurance providers and health plans
  • Follow up on denials while partnering with Utilization Review, Business Office, and Case Management teams
  • Maintain accurate tracking of government and payer audits, including RAC, MAC, CERT, ADR, QIO, Medicaid, and pre/post-payment reviews
  • Provide support with Release of Information, discharge coordination, and other assigned departmental duties

Qualifications
  • High School Diploma or equivalent
  • Two years of relevant experience
  • Accurate alphabetic, numeric, and/or terminal-digit filing skills
  • Computer data entry with 10-key, with accurate typing speed of 35 wpm
  • Associates Degree or higher, preferred
  • Excel skills. highly preferred
  • Knowledge of terminal digit filing and medical terminology, preferred
  • Knowledge of State and Federal regulatory requirements for medical staff documentation, preferred
  • Completion of a medical terminology course, preferred
  • Background in business and office training, preferred

Here are some of the benefits of working at Prime Healthcare:
  • Health, dental, and vision insurance options
  • Paid vacation, sick time and holidays
  • Bereavement leave, FMLA and other leave options
  • Employer 401K options
  • Tuition reimbursement options
  • Life, disability, and other insurance options
  • Many other amazing benefits

Full benefits at Prime Healthcare: https://www.primehealthcare.com/careers/benefits/
#LI-MP1
Employment Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

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