ZipRecruiter

Log In

1

Utilization Review Social Worker 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 Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

Prime Healthcare

Utilization Review Tech

Lynwood, CA

$23 - $24.45/hr

Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will ...

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 ... Required with licensure, APRN, LPC, LMSW, LCSW, RN preferred EEO Statement: All UHS subsidiaries ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND ...

Charlie Health

Utilization Review Specialist

$62K - $70K/yr

Completes peer to peer reviews with insurance MDs to advocate for treatment post first line denial ... Master's-Level Clinicians: LCSW, LMFT, LPC, or LCPC. * 2+ years of experience in a utilization role ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND ...

previous page

Showing results 41-60

All JobsUtilization Review Social Worker Jobs

Utilization Review Social Worker information

See salary details

$21

$42

$68

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

As of Sep 3, 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 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 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 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.

More about Utilization Review Social Worker jobs

What cities are hiring for Utilization Review Social Worker jobs?

Cities with the most Utilization Review Social Worker job openings:

What are the most commonly searched types of Utilization Review Social Worker jobs?

The most popular types of Utilization Review Social Worker jobs are:

What states have the most Utilization Review Social Worker jobs?

States with the most job openings for Utilization Review Social Worker jobs include:

What job categories do people searching Utilization Review Social Worker jobs look for?

The top searched job categories for Utilization Review Social Worker jobs are:

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, 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 $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Fusion HCR

Las Vegas, NV • On-site

Other

This job post has expired 2 days ago. Applications are no longer accepted.

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