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Utilization Review Physician Assistant 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 ...

Hired by Matrix

RN Utilization Review

Portales, NM · On-site

Communicate with physicians to ascertain their plans for a timely discharge. * Document updates and ... necessary. * Assist with obtaining referrals, prior authorization for Home Health Care, CME, SNF ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare ... Utilization Management (UM) * Medical Necessity Review * Prior Authorization * Precertification

Franciscan Health

Utilization Review Coordinator

Communicate with physicians, patients, members of the Healthcare team, Coordinated Business Office ... Utilization Review Coordinator $56971.20-$84749.60 INCENTIVE: Not Applicable EQUAL OPPORTUNITY ...

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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 Aug 15, 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?

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 August 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 Nurse

Fusion HCR

Las Vegas, NV • On-site

Other

Re-posted 9 days ago

Job description

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations

Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines

Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines

Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!

Apply