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Utilization Review Social Worker Jobs (NOW HIRING)

UHS

Utilization Review Clinician

Augusta, GA

Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC) Nurses with a ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN ...

UHS

Utilization Review Clinician

Augusta, GA

Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC) Nurses with a ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN ...

BJC HealthCare

Clinical Social Worker

Alton, IL · On-site

$63K - $102K/yr

Case Management, Utilization Review, Social Services: Provides admission and continued stay reviews ... Lic Clinical Social Worker Preferred Requirements Experience * 2-5 years Benefits and Legal ...

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

$50K - $65K/yr

Utilization Review Specialist | Remote | Full-Time $50,000 - $65,000 Annually | Weekdays (Weekend ... Clinical licensure (LCSW, LMHC, LPC, RN, or equivalent) - valued but not required * Experience ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... LMSW, LCSW, etc) EXPERIENCE: A minimum of five (5) years direct clinical experience in a ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... LMSW, LCSW, etc) EXPERIENCE: A minimum of five (5) years direct clinical experience in a ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... LMSW, LCSW, etc) EXPERIENCE: A minimum of five (5) years direct clinical experience in a ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... LMSW, LCSW, etc) EXPERIENCE: A minimum of five (5) years direct clinical experience in a ...

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How much do utilization review social worker jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for utilization review social worker 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 are the key skills and qualifications needed to thrive as a utilization review social worker?

To thrive as a Utilization Review Social Worker, you need a solid background in social work, case management, and healthcare regulations, typically supported by an MSW degree and licensure (LCSW or equivalent). Familiarity with utilization management software, EMR/EHR systems, and knowledge of insurance protocols are often required. Strong analytical thinking, attention to detail, effective communication, and empathy are key soft skills for success in this role. These abilities ensure informed decision-making, efficient patient care coordination, and effective advocacy during the review process.

What is a utilization review social worker?

A Utilization Review Social Worker evaluates patient care to ensure it meets medical necessity and insurance guidelines. They review treatment plans, coordinate with healthcare providers, and communicate with insurance companies to secure appropriate coverage. Their goal is to optimize healthcare resources while ensuring patients receive necessary care. They also help prevent unnecessary hospitalizations and advocate for patient needs within healthcare systems.

What are some common challenges utilization review social workers face in their day-to-day work?

Utilization Review Social Workers often need to balance patient advocacy with healthcare cost containment, which can require navigating complex insurance guidelines and policies. They frequently review medical records to determine medical necessity and may have to communicate difficult decisions to patients, families, or care teams. Managing a high caseload while meeting documentation and regulatory requirements can also be demanding. However, this role offers opportunities for professional growth, multidisciplinary collaboration, and making a positive impact on patient care outcomes.

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What cities are hiring for Utilization Review Social Worker jobs? Cities with the most Utilization Review Social Worker job openings:
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Utilization Review Social Worker jobs near you
Infographic showing various Utilization Review Social Worker job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Behavioral Health Social Worker, Utilization Review, Days

ScionHealth

Palestine, TX • On-site

Full-time

Re-posted 28 days ago

ScionHealth rating

5.6

Company rating: 5.6 out of 10

Based on 49 frontline employees who took The Breakroom Quiz

798th of 887 rated healthcare providers

Job description

Join Palestine Regional Medical Center in Palestine, TX, a 150-bed hospital that has recently earned the prestigious Leapfrog "A" Safety Grade, the Platinum Award for quality from parent-company ScionHealth, and certification as a Chest Pain Center and Level IV Trauma facility. Palestine Regional provides a range of comprehensive care, including the latest in diagnostic, therapeutic, and rehabilitative services, both on an inpatient and outpatient basis. Palestine Regional is an integral part of the local community, giving you the chance to grow your career while making a real impact close to home.
Job Summary
The Social Worker-Utilization Review monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, admissions, and extended stays. The Social Worker-Utilization Review performs pre-certification, concurrent review, and discharge planning in accordance with applicable guidelines and acts as a liaison to support safe, timely, and medically necessary care.
Essential Functions
  • Ensures the medical necessity and appropriateness of all hospital admissions per established criteria
  • Performs concurrent medical record reviews to justify continued stay and documents appropriately
  • Coordinates with care team to facilitate timely and effective discharge planning
  • Communicates with third-party payers and managed care entities to provide required documentation
  • Collaborates with social services and case management to streamline patient transitions and reduce readmissions
  • Reviews and monitors patient charts in alignment with medical staff performance improvement metrics
  • Contributes to organizational quality goals and achieves performance targets in a timely manner

Knowledge/Skills/Abilities/Expectations
  • Strong clinical assessment and critical thinking skills
  • Ability to interpret medical records, criteria, and regulations
  • Knowledge of utilization review processes, discharge planning, and payer requirements
  • Proficient in communication and coordination with interdisciplinary teams
  • Skilled in documentation, confidentiality practices, and health information systems
  • Demonstrates resilience, adaptability, and the ability to manage stress effectively
  • Frequent use of computers and telephone
  • Must be able to sit or stand for prolonged periods
  • Occasional lifting of up to 25 pounds
  • Frequent walking and light movement required during audits or rounding
  • Hospital setting with exposure to general healthcare conditions
  • May involve contact with patients, families, and medical records
  • Potential exposure to communicable diseases, bloodborne pathogens, and chemicals
  • Fast-paced environment requires focus, accuracy, and confidentiality

Qualifications
Education
  • Bachelor of Social Work degree from an accredited school of social work (Required) and
  • Master of Social Work degree from an accredited school of social work (Preferred)

Licenses/Certifications
  • Licensed in the state of practice as LBSW, LMSW, or LCSW.
  • License must be current and without restrictions.

Experience
  • Two (2) years of progressive clinical experience preferred; psychiatric healthcare experience desirable

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