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Utilization Review Physician Assistant Jobs (NOW HIRING)

Randolph Health

Utilization Review Nurse

Asheboro, NC · On-site

$21.47 - $35/hr

Timely notification of the admitting physician on any issues of status that need discussion and ... level of care decisions. Assist with case reviews for payer denials concurrently and ...

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

ADP, Inc.

Utilization Review Specialist

Knoxville, TN · On-site

$60 - $80/hr

... physicians, nurses, and insurance representatives, to gather necessary information and explain ... of utilization review activities. Continuous learning and adaptability are important to stay ...

New

Socket.dev

Utilization Review Specialist

Knoxville, TN · On-site

$60 - $85/hr

... physicians, nurses, and insurance representatives, to gather necessary information and explain ... of utilization review activities. Continuous learning and adaptability are important to stay ...

New

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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 Sep 7, 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 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.

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.

Can physician assistants do utilization review?

Yes, physician assistants can perform utilization review tasks, which involve evaluating the necessity, appropriateness, and efficiency of healthcare services. They often work in collaboration with physicians and may require certification or training in utilization review processes, depending on the healthcare setting and state regulations.
More about Utilization Review Physician Assistant jobs

What cities are hiring for Utilization Review Physician Assistant jobs?

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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 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $139,887 per year, or $67.3 per hour.

Utilization Review Nurse

Houston Healthcare

Warner Robins, GA • On-site

Full-time

Posted 13 days ago

Job description

Work Shift:

The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay. The Utilization Reviewer serves as a resource to medical and hospital staff on utilization and regulatory issues and participates in coordination of individualized patient care services. The Utilization Reviewer plays an integral role in discharge planning and maximizing the continuum of care for patients assigned to his/her assigned unit. The Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for the patient.
Qualifications:
Education & Training:
Graduate of an accredited School of Nursing.
Experience:
Three (3) years in an acute care setting.
Required Certification/Registration/Licensure:
Current US state RN license with authorization to practice in the state of GA.
Knowledge, Skills & Abilities:
Utilizes a variety of standard office equipment to include computer, printer, fax machine, copier, telephone etc. Basic knowledge of statistics encouraged.

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.

Scheduled Weekly Hours:

40

FTE:

1

Expanded Work Shift:

On Call:

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