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Utilization Review Physician Assistant Jobs (NOW HIRING)

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... We provide customized Independent Medical Exams and Peer Review programs that assist our clients in ...

Discovery Institute NJ

Utilization Review

Marlboro, NJ · On-site

Monitor payer portals for authorization updates. * Assist with Medicaid and managed care authorization processes. * Participate in utilization review meetings and case conferences. * Generate reports ...

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Utilization Review Physician Assistant information

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$42K

$139.9K

$187.5K

How much do utilization review physician assistant jobs pay per year?

As of Jul 26, 2026, the average yearly pay for utilization review physician assistant in the United States is $139,887.00, according to ZipRecruiter salary data. Most workers in this role earn between $121,500.00 and $157,000.00 per year, depending on experience, location, and employer.

What is a Utilization Review Physician Assistant?

A Utilization Review Physician Assistant (PA) is a healthcare professional who evaluates medical records and treatment plans to ensure that patient care is medically necessary, appropriate, and cost-effective. They review cases to determine if the care provided meets established guidelines and insurance requirements. Utilization Review PAs collaborate with physicians, nurses, insurance companies, and other healthcare providers to promote quality care while managing healthcare resources efficiently. Their work typically involves less direct patient care and more administrative responsibilities compared to traditional clinical PA roles.

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

To thrive as a Utilization Review Physician Assistant, you need a strong clinical background, current PA licensure, and in-depth knowledge of medical guidelines and insurance protocols. Familiarity with electronic medical records (EMRs), utilization management software, and relevant certification such as the Certified Professional in Utilization Review (CPUR) is often beneficial. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for evaluating cases and interacting with healthcare providers and payers. These competencies are essential to ensure appropriate care delivery, compliance with regulations, and cost-effective use of medical resources.

What is the difference between Utilization Review Physician Assistant vs Utilization Review Nurse Practitioner?

AspectUtilization Review Physician AssistantUtilization Review Nurse Practitioner
CredentialsMaster's degree, Physician Assistant (PA) license, certification (e.g., NCCPA)Master's or higher degree, Nurse Practitioner (NP) license, certification (e.g., ANCC, AANP)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, clinics, insurance companies
Employer & Industry UsageCommonly employed in healthcare and insurance sectors for review rolesSimilar usage, often in outpatient and insurance settings

Both roles involve reviewing medical necessity and appropriateness of care, but the Physician Assistant typically has a medical model training background, while the Nurse Practitioner has a nursing model. Both are vital in utilization review, with overlapping responsibilities and work environments.

What are some of the main challenges Utilization Review Physician Assistants face when transitioning from direct patient care to a review-focused role?

One of the main challenges Utilization Review Physician Assistants encounter is adapting to a predominantly administrative and analytical environment, as opposed to the hands-on patient care they may be accustomed to. The role requires interpreting clinical documentation, applying payer criteria, and making objective determinations about medical necessity, often with limited patient interaction. Additionally, there can be pressure to meet productivity targets and deadlines while maintaining accuracy and fairness in reviews. Collaboration with physicians, case managers, and insurance representatives is frequent, requiring strong communication and negotiation skills.
More about Utilization Review Physician Assistant jobs
What cities are hiring for Utilization Review Physician Assistant jobs? Cities with the most Utilization Review Physician Assistant job openings:
What states have the most Utilization Review Physician Assistant jobs? States with the most job openings for Utilization Review Physician Assistant jobs include:
What job categories do people searching Utilization Review Physician Assistant jobs look for? The top searched job categories for Utilization Review Physician Assistant jobs are:
Utilization Review Physician Assistant jobs near you
Infographic showing various Utilization Review Physician Assistant job openings in the United States as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $139,887 per year, or $67.3 per hour.
Utilization Review Physician

Utilization Review Physician

Vivo HealthStaff

Carteret, NJ • On-site

Full-time

Posted just now

Job description

Vivo HealthStaff is recruiting for a Utilization Review Physician based in New York for a Managed Care Insurance Plan. This position requires 4 days per month on-site.
The Utilization Review Physician is the lead clinician for the health plan. Responsible for the administration of medical services for company health plan utilizing the evidence-based medical policies and clinical guidelines of the plan, to ensure the appropriate and most cost-effective medical care is accessible and delivered to our members. Drives direction of the plan related to cost of care, clinical initiatives and population health management and outcomes.
Will function as the clinical lead, working alongside state plan president as the team interfaces with state regulators, providers and market facilities.
Requirements:
  • Board Certification in a specialty certified by either the American Board of Medical Specialties or American Osteopathic Association
  • Unrestricted Medical License in the State of New York
  • Minimum of 10 years of clinical practice post residency
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About Vivo HealthStaff

Sourced by ZipRecruiter

Vivo HealthStaff provides permanent recruitment services for both clinical and administrative positions in the healthcare sector. Over the past 2 years, our clients have seen a 98% retention rate with Vivo HealthStaff placements.

Industry

Health care and social assistance

Company size

11 - 50 Employees

Headquarters location

Dublin, CA, US

Year founded

2016

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