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Utilization Review Specialist Jobs (NOW HIRING)

ABHS

Utilization Review Specialist

Evesham, NJ · On-site

$55K - $65K/yr

General Description The Utilization Review Specialist processes all insurance authorizations for partial hospitalization programs, intensive outpatient programs and outpatient programs across ...

Sevita

Utilization Review Specialist

Akron, OH · On-site

$40K/yr

SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate documentation of services delivered for audit assurances, and positive outcomes regarding effective ...

Charlie Health

Utilization Review Specialist

$62K - $70K/yr

Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations * Familiarity with InterQual, MCG, or similar clinical guidelines * Strong analytical, communication ...

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How much do utilization review specialist jobs pay per hour?

As of Sep 3, 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 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 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.

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.

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.

How much does a utilization review specialist make in California?

The average salary for a utilization review specialist in California ranges from $60,000 to $80,000 annually, depending on experience, certifications, and location. Salaries may also vary based on the employer and whether the role is full-time or part-time, with some positions offering additional benefits or bonuses.

Is utilization review a good job?

Utilization Review Specialists evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role typically requires strong analytical skills, attention to detail, and knowledge of healthcare regulations, with opportunities for certification and career advancement. It can offer stable employment and a predictable schedule, but job satisfaction depends on individual preferences and work environment.
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Utilization Review Specialist jobs near you
Infographic showing various Utilization Review Specialist 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 $66,436 per year, or $31.9 per hour.

Utilization Review Specialist

Desert Parkway Behavioral Healthcare Hospital

Las Vegas, NV • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 20 days ago

Job description

We are looking for a detailed-oriented Utilization Review (UR) Specialist to help us maximize patient care quality and ensure seamless insurance operations.

The UR Specialist evaluates patient medical records to ensure treatments meet clinical necessity and regulatory standards. You will serve as the primary bridge between our medical staff and insurance providers, facilitating timely care approvals and minimizing claim denials.

Other responsibilities include retrieving discharge documents on a daily basis from charts, faxing when applicable, and retrieving authorizations.

KEY RESPONSIBILITIES:

  • Evaluate outpatient charts against established clinical criteria.
  • Submit and track insurance authorization requests.
  • Draft and submit clinical appeals for denied services.
  • Communicate directly with insurance medical directors and case managers.
  • Advise physicians and clinical staff on documentation requirements.
  • Monitor utilization trends, denial rates, and approval timelines.
  • Ensure adherence to Medicare, Medicaid, and private payer guidelines.
  • Hours are Monday - Friday from 8:00am - 4:30pm

Requirements

  • Current LPN, RN or other Clinical Licensure and/or master’s degree required.
  • Minimum two (2) years of clinical experience, with 1+ years in utilization review or case management required
  • Knowledge of Nevada Payors required
  • Previous experience working in behavioral healthcare strongly preferred
  • Strong Microsoft word and excel skills required
  • Maintains confidentiality of patients at all times

Benefits

Eligible for benefits 1st of the month following one month of employment.

Desert Parkway offers competitive benefits to include:

  • Health insurance
  • Vision insurance
  • Dental insurance
  • 401K Retirement Plan
  • Healthcare spending account
  • Dependent care spending account
  • PTO Plan with holiday premium pay
  • Discounted cafeteria meal plan
  • Life insurance (Supplemental Life, Term and Universal plans are also available)
  • Short- and long-term disability (with additional buy-in opportunities)