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Utilization Review Specialist Jobs (NOW HIRING)

PARKSIDE INC

Utilization Review Specialist

Tulsa, OK · On-site

The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing an intentionally different approach to mental health and well-being. We are a combination of bricks ...

Umpqua Health

Utilization Review Specialist

Winston, OR · On-site

$41K - $47K/yr

Utilization Review Specialist HYBRID, must be able to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470 EMPLOYMENT TYPE- Full-Time, Exempt About Umpqua Health At Umpqua Health, we're more than a ...

Sheppard Pratt

Utilization Review Specialist

Towson, MD · On-site

$26.04/hr

Responsible for supporting the utilization review system including data analysis, report writing, and program improvement. * UR Specialist will develop and maintain a VOD Tracking and Receipt system.

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Utilization Review Specialist information

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$31

$53

How much do utilization review specialist jobs pay per hour?

As of Jul 17, 2026, the average hourly pay for utilization review specialist in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.

What jobs pay 4000 a week without a degree?

Utilization Review Specialists typically do not earn $4,000 weekly without a degree, as this role usually requires healthcare or insurance industry knowledge and certifications. High-paying jobs that can reach this level without a degree often include skilled trades like commercial driving, sales, or certain entrepreneurial ventures, but these are less common and may require experience or licensing. Most jobs paying $4,000 a week without a degree are in specialized fields or involve self-employment.

What is the most chill healthcare job?

A Utilization Review Specialist typically works in a healthcare setting reviewing medical cases to determine coverage and appropriateness of care. The role often involves standard office hours, minimal physical demands, and requires strong attention to detail, making it a relatively low-stress position compared to more clinical or emergency roles.

How does a Utilization Review Specialist typically interact with healthcare providers and insurance companies?

Utilization Review Specialists serve as a key liaison between healthcare providers and insurance companies, reviewing patient records to ensure medical necessity and compliance with coverage guidelines. They frequently communicate with physicians and clinical staff to clarify documentation or treatment plans, as well as with insurance representatives to justify or appeal coverage decisions. This collaborative environment requires strong communication skills and a thorough understanding of medical protocols and payer requirements, making teamwork and attention to detail essential aspects of the role.

Is utilization review a stressful job?

Utilization review specialists often work in fast-paced healthcare environments where accuracy and efficiency are important, which can contribute to job stress. The role involves reviewing medical cases and making determinations that impact patient care, requiring attention to detail and adherence to policies, but stress levels vary depending on workload, support, and individual coping skills.

What Is a Utilization Review Specialist?

Utilization review specialists assess plans for patient care and determine what treatment is appropriate and most cost-effective. They investigate disputed medical claims, coordinate utilization training for the medical staff, analyze electronic medical records, and inform medical staff whether a medical claim is denied, approved, under review, or under appeal. In many cases, the utilization review specialist serves as an advocate for quality patient care, cost reduction, and hospital quality standards.

What is a utilization review specialist?

A utilization review specialist evaluates medical services to determine their necessity, appropriateness, and efficiency for insurance companies or healthcare providers. They review patient records, ensure compliance with guidelines, and often work with healthcare professionals to approve or deny claims, typically requiring knowledge of medical coding and insurance policies.

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

To thrive as a Utilization Review Specialist, you need a background in healthcare, strong analytical abilities, and typically a degree in nursing, social work, or a related field, often with relevant licensure. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance and regulatory guidelines are essential. Excellent communication, critical thinking, and attention to detail are crucial soft skills for collaborating with providers and advocating for appropriate patient care. These competencies ensure accurate assessments, regulatory compliance, and optimal resource utilization in healthcare settings.

What is the difference between Utilization Review Specialist vs Claims Reviewer?

AspectUtilization Review SpecialistClaims Reviewer
CredentialsOften requires healthcare-related certifications (e.g., RN, CPC)Typically requires insurance or billing certifications
Work EnvironmentHealthcare settings, insurance companies, hospitalsInsurance companies, healthcare payers, third-party administrators
Job FocusAssess medical necessity and appropriateness of servicesReview insurance claims for accuracy and coverage

While both roles involve reviewing healthcare-related information, the Utilization Review Specialist primarily evaluates the medical necessity of treatments, whereas the Claims Reviewer focuses on verifying insurance claims for correctness and coverage. Both positions require knowledge of healthcare and insurance processes but serve different functions within the healthcare and insurance industries.

What are Utilization Review Specialists?

Utilization Review Specialists are healthcare professionals who assess the necessity, appropriateness, and efficiency of medical services and treatments provided to patients. They review patient records, treatment plans, and insurance information to ensure that care meets established guidelines and is medically necessary. Their work helps manage healthcare costs, prevent unnecessary procedures, and ensure compliance with regulations and insurance policies. Utilization Review Specialists often work for hospitals, insurance companies, or other healthcare organizations.
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Utilization Review Specialist jobs near you
Infographic showing various Utilization Review Specialist job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.
Utilization Review Specialist

Utilization Review Specialist

Northlake Behavioral Health System

Mandeville, LA

Full-time

Re-posted 6 days ago

Job description

Position: Utilization Review Specialist

Status: Full Time, Days

Schedule: Mon-Fri, Days. New hire will have the option to choose a schedule of either 7:30am to 4:00pm or 8:00am to 4:30pm.
Are you experienced in navigating medical insurance authorizations? We're looking for a Utilization Review Specialist to ensure our inpatient psychiatric patients receive timely access to the care they need — and that our facility is appropriately reimbursed for the services we provide.

In this role, you'll conduct admission, concurrent, and continued stay reviews with managed care organizations, commercial insurers, and government payers. You'll work closely with psychiatrists, nurses, therapists, and case managers to make sure clinical documentation supports medical necessity, and you'll manage denials and appeals to protect both patient access and reimbursement.

What You'll Do

Utilization Review & Authorizations

  • Conduct admission, concurrent, and continued stay reviews for inpatient behavioral health patients

  • Evaluate patient records against payer medical necessity and level-of-care criteria

  • Complete telephonic and electronic reviews with managed care organizations and third-party payers

  • Secure initial and continued stay authorizations; track authorization periods and obtain extensions

  • Submit clinical information on time to prevent authorization lapses and reimbursement delays

Denials & Appeals

  • Review denials and coordinate reconsiderations, peer-to-peer reviews, and appeals

  • Prepare appeal packets with supporting clinical documentation

  • Monitor denial trends and identify ways to improve authorization outcomes

Clinical Documentation & Team Collaboration

  • Review psychiatric, nursing, and therapy documentation for accuracy and medical necessity support

  • Coach providers and clinical staff on documentation improvements

  • Participate in treatment team discussions to support medical necessity and discharge planning

  • Serve as the go-to resource on behavioral health payer criteria and UR processes

Data & Compliance

  • Maintain authorization, denial, and appeal tracking logs with timely, accurate data entry

  • Assist with audits, reporting, and performance improvement initiatives

  • Maintain compliance with federal/state regulations, accreditation standards, and HIPAA

What We're Looking For

Required:

  • Associate's degree in healthcare related field — OR a high school diploma/GED with at least 4 years of psychiatric, behavioral health, utilization review, case management, admissions, or related healthcare experience

  • Min 2 years of experience in a psychiatric, behavioral health, or healthcare setting

  • Knowledge of managed care, medical necessity criteria, utilization review, third-party reimbursement, and clinical documentation review

  • Strong organization and time management — you'll juggle multiple payer reviews and deadlines

Ready to apply? Submit your resume today

Northlake Behavioral Health is an equal opportunity/affirmative action employer. All qualified applicants are encouraged to apply and will receive consideration for all employment; free from discrimination based on race, creed, color, national origin, age, sex, pregnancy, sexual orientation, gender identity, genetic information, religion, associational preferences, status as a qualified individual with a disability, or status as a protected veteran.