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Utilization Review No Experience Jobs (NOW HIRING)

Prime Time Healthcare

Utilization Review

Washington, DC · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

Now Hiring: RN Utilization Review - Washington, DC Are you a passionate RN professional looking for a new adventure? Prime Time Healthcare is seeking dynamic individuals like you to join our team in ...

ARcare

Utilization Review Associate

Searcy, AR · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

High school diploma Experience: two years experience with Microsoft Office and office work Computer ... No routine nights or weekends for most positions. (Some clinical roles may have limited weekend ...

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

$50K - $65K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Review Specialist | Remote | Full-Time $50,000 - $65,000 Annually | Weekdays (Weekend Availability as Needed) Banyan Treatment Centers is seeking an experienced and detail-driven ...

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 ... Strong experience utilizating MCG (Milliman Care Gudielines) * 1+ years of clinical experience ...

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Utilization Review No Experience information

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How much do utilization review no experience jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for utilization review no experience 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 No Experience vs Utilization Review Coordinator?

AspectUtilization Review No ExperienceUtilization Review Coordinator
Required CredentialsHigh school diploma or equivalent; on-the-job trainingHigh school diploma; certification may be preferred
Work EnvironmentEntry-level, training-focused, healthcare settingsOffice-based, healthcare facilities, insurance companies
Employer & Industry UsageHospitals, insurance companies, healthcare providersInsurance companies, healthcare organizations, managed care
Search & Comparison IntentEntry-level, no experience, trainingCoordination, case management, healthcare review

Utilization Review No Experience roles are entry-level positions requiring minimal credentials and focus on training within healthcare settings. In contrast, Utilization Review Coordinators typically have some experience or certification, handling case management and review tasks in healthcare or insurance environments. Both roles are essential in healthcare utilization management but differ mainly in experience requirements and responsibilities.

What is utilization review?

Utilization review is a process used in healthcare to assess the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities. Many entry-level utilization review positions are available for individuals with clinical backgrounds, such as nurses or social workers, even if they do not have prior experience in utilization review specifically. Employers often provide on-the-job training for candidates who understand medical terminology and have a background in healthcare. If you do not have a clinical license, you may need to seek administrative or support roles in utilization review to gain experience.

What are the key skills and qualifications needed to thrive as a utilization review specialist with no prior experience?

To thrive as a Utilization Review Specialist without prior experience, you generally need a healthcare-related degree, strong analytical skills, and a good understanding of medical terminology. Familiarity with case management software, electronic health records (EHR), and UR-specific platforms is typically required, and some roles may prefer candidates to pursue certification like Certified Utilization Review Specialist (CURA) over time. Attention to detail, effective communication, and strong organizational skills help new professionals excel in assessing medical necessity and collaborating with healthcare teams. These competencies ensure accurate reviews, regulatory compliance, and positive patient outcomes in a complex healthcare environment.

What are common challenges faced by entry-level professionals in utilization review and how can they be addressed?

Entry-level professionals in Utilization Review often face challenges such as learning complex medical terminology, understanding insurance regulations, and adapting to fast-paced review processes. To overcome these, it's helpful to seek mentorship from experienced team members, utilize available training resources, and stay organized with case management tools. Regular communication with clinical staff and supervisors also helps clarify protocols and expectations, making it easier to build confidence and competence in the role.
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Utilization Review No Experience jobs near you
Infographic showing various Utilization Review No Experience job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, and 4% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL

Full-time

Re-posted 5 days ago

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

· Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  • Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

· Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

· Bachelor of Science in Nursing (BSN) preferred.

· Case Management Certification (e.g., CCM) is a plus.

· Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

· Minimum 2 years of work experience in Utilization Review

· Strong understanding of revenue cycle management and healthcare reimbursement.

· Proficiency in medical coding and clinical documentation improvement.

· Excellent communication, interpersonal, and teamwork skills.

· Ability to work independently and make sound clinical and financial decisions.

· Strong analytical and problem-solving skills.

· Proficient in using healthcare information systems and technology.

· Commitment to maintaining patient confidentiality and ethical standards.

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