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Utilization Review Therapist Jobs (NOW HIRING)

UHS

Utilization Review Coordinator

Augusta, GA · On-site

... with physicians, therapist, nurses and pertinent staff on gathering the necessary data to ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...

UHS

Director of Utilization Review

Gulfport, MS

Current license in the state of Missisippi, including RN, LMSW, LMFT, LPC EEO Statement All UHS ... and the utilization review process including concurrent reviews. Previous continuum of care ...

UHS

Director of Utilization Review

Gulfport, MS · On-site

Current license in the state of Missisippi, including RN, LMSW, LMFT, LPC EEO Statement All UHS ... and the utilization review process including concurrent reviews. Previous continuum of care ...

UHS

Director of Utilization Review

Gulfport, MS

Current license in the state of Missisippi, including RN, LMSW, LMFT, LPC EEO Statement All UHS ... and the utilization review process including concurrent reviews. Previous continuum of care ...

UHS

Utilization Review Coordinator

Scottsdale, AZ · On-site

Responsibilities Utilization Review Coordinator Full Time and PRN/Per Diem available Via Linda ... Registered Nurse or licensed as an LMSW, LCSW, LPC, MFT or similar AZ Board of Behavioral Health ...

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How much do utilization review therapist jobs pay per hour?

As of Jul 17, 2026, the average hourly pay for utilization review therapist 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 Therapist job?

A Utilization Review (UR) Therapist evaluates the medical necessity, appropriateness, and efficiency of mental health or substance use treatments. They review patient records, collaborate with providers, and ensure that care meets insurance requirements and clinical guidelines. Their goal is to balance quality patient care with cost-effective treatment, often working closely with insurance companies and healthcare teams to approve or appeal coverage decisions.

What are the typical daily responsibilities of a Utilization Review Therapist?

As a Utilization Review Therapist, your daily duties often include reviewing clinical documentation, determining the medical necessity of treatments, and coordinating with healthcare providers to ensure appropriate levels of care. You will interact frequently with insurance companies to facilitate authorizations and manage denials or appeals. Collaboration with other clinical staff is common, as you gather information and advocate for patient care. Occasionally, you may participate in interdisciplinary meetings or provide education on documentation standards and payer requirements.

What are the key skills and qualifications needed to thrive in the Utilization Review Therapist position, and why are they important?

To thrive as a Utilization Review Therapist, you need strong clinical assessment skills, a background in behavioral health or social work, and a relevant license such as LCSW, LMFT, or LPC. Familiarity with insurance guidelines, electronic medical record (EMR) systems, and utilization management software is often required. Excellent critical thinking, organization, and communication skills help you succeed in this role. These competencies ensure accurate treatment evaluations, compliance with regulations, and effective collaboration across clinical and administrative teams.

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What cities are hiring for Utilization Review Therapist jobs? Cities with the most Utilization Review Therapist job openings:
What are the most commonly searched types of Utilization Review Therapist jobs? The most popular types of Utilization Review Therapist jobs are:
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Utilization Review Therapist jobs near you
Infographic showing various Utilization Review Therapist 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/Reimbursement Specialist

Utilization Review/Reimbursement Specialist

Sinai Chicago

Chicago, IL • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 17 days ago

Sinai Chicago rating

7.8

Company rating: 7.8 out of 10

Based on 15 frontline employees who took The Breakroom Quiz

Job description

About Sinai Chicago
At Sinai Health System d/b/a Sinai Chicago, we take health care personally. Excellence in health care is about more than medicine, technology, tests, and treatments-it is about caring for people with dignity, compassion, and respect. We are committed to delivering exceptional care to our patients, supporting our communities, and creating meaningful career opportunities for our caregivers.
Position Summary
The Utilization Review/Reimbursement Specialist is responsible for coordinating Medical Record and Utilization Management activities in accordance with Sinai Chicago Medical Staff standards and applicable regulatory requirements. This role reviews medical records to determine the medical necessity and appropriateness of post-acute care services, secures insurance authorizations, conducts extended stay reviews, and supports patient access to inpatient rehabilitation services.
The specialist works collaboratively across the Sinai Chicago network to manage denial prevention and appeals, ensure timely payer approvals, optimize reimbursement, and promote access to the appropriate level of care.
Essential Job Responsibilities
Utilization Management & Authorization
  • Coordinate utilization management review functions in accordance with the Hospital Utilization Review Plan, including:
    • Preadmission reviews
    • Admission reviews
    • Continued stay reviews
    • Discharge planning reviews
  • Evaluate medical necessity, eligibility, appropriateness of care, and level-of-care determinations.
  • Analyze insurance, governmental, and accreditation agency requirements related to admissions, treatment plans, and length of stay.
  • Conduct complex case reviews to determine inpatient admission criteria.
  • Manage prior authorizations, recertifications, and payer communications via phone, fax, or electronic platforms.
  • Facilitate insurance approval processes to ensure appropriate patient access to inpatient rehabilitation services.
  • Implement strategies to streamline authorization processes and minimize delays in care.
Reimbursement & Denial Management
  • Develop and execute denial prevention and management strategies.
  • Maintain thorough documentation of denial management activities, outcomes, and payer communications.
  • Review medical records for reimbursement compliance and appeal opportunities.
  • Draft and coordinate insurance appeal letters and supporting documentation on behalf of patients.
  • Assist in maximizing reimbursement while maintaining compliance with payer requirements and clinical standards.
Departmental Support
  • Support departmental and organization-wide educational initiatives.
  • Assist with reviewing, updating, and improving utilization review policies and procedures.
  • Develop and maintain positive working relationships with insurance payers and referral sources.
  • Perform admission office responsibilities as assigned by leadership.
  • Participate in special projects and other duties as assigned.
Diversity, Equity, Inclusion, and Belonging
The Utilization Review/Reimbursement Specialist is expected to promote Sinai Chicago's commitment to Diversity, Equity, and Inclusion by:
  • Treating all individuals with dignity and respect.
  • Supporting opportunities for underrepresented communities.
  • Encouraging talent development and growth.
  • Identifying and helping eliminate disparities.
  • Taking action against bias, racism, and injustice.
  • Honoring differences and fostering collaboration.
  • Educating staff, patients, and community members.
  • Supporting the mission of restoring hope and freedom for all.
Customer Service Expectations
  • Demonstrate exceptional customer service and professional behavior.
  • Promote teamwork, collaboration, and effective communication.
  • Maintain confidentiality and discretion when handling sensitive information.
  • Foster positive relationships with patients, families, colleagues, physicians, and external partners.
  • Serve as a role model for outstanding customer service and organizational values.
Quality Improvement Responsibilities
  • Identify opportunities for process improvement and operational efficiency.
  • Participate in departmental quality initiatives and performance improvement activities.
  • Support efforts to monitor and improve patient and family satisfaction.
  • Report issues and recommend solutions that enhance patient outcomes and service quality.
  • Perform additional duties as assigned.
Education & Experience
Required
  • Bachelor's degree or equivalent professional degree in one of the following disciplines:
    • Nursing
    • Social Work
    • Physical Therapy
    • Occupational Therapy
    • Speech Therapy
    • Athletic Training
    • Related healthcare field
  • Minimum of 2 years of Utilization Management experience.
Preferred
  • Experience in post-acute care, rehabilitation services, or care coordination.
  • Experience working with managed care organizations and third-party payers.
Knowledge, Skills & Abilities
  • Strong understanding of utilization review principles, reimbursement practices, and medical necessity criteria.
  • Excellent written and verbal communication skills.
  • Demonstrated proficiency in spelling, grammar, and professional correspondence.
  • Ability to effectively collaborate with physicians, clinicians, and administrative staff.
  • Strong analytical and problem-solving skills.
  • Proficiency with personal computers and healthcare information systems.
  • Experience with:
    • EPIC (preferred)
    • MEDITECH (preferred)
  • Ability to manage multiple priorities in a fast-paced healthcare environment.
Licenses & Certifications
Required
  • Valid driver's license with no restrictions.
Preferred
  • Registered Health Information Technician (RHIT)
  • Registered Health Information Administrator (RHIA)

Benefits
Sinai Chicago offers a competitive and comprehensive benefits package, which may include:
  • Medical, Dental, and Vision Insurance
  • Prescription Drug Coverage
  • Employer-Paid Life Insurance and AD&D
  • Supplemental Life Insurance
  • Short-Term and Long-Term Disability
  • Health Savings Account (HSA)
  • Flexible Spending Account (FSA)
  • Employee Assistance Program (EAP)
  • Student Loan Assistance Program
  • 403(b) Retirement Savings Plan
  • Paid Leave Programs

Eligibility for certain benefits is based on scheduled hours worked and completion of applicable waiting periods.
Sinai Chicago Values
All caregivers are expected to demonstrate the following values:
Teamwork
Collaborates effectively to create an inclusive and supportive workplace.
Respect
Treats all individuals with dignity, fairness, and appreciation.
Quality
Strives for excellence through continuous improvement and adherence to best practices.
Integrity
Demonstrates honesty, accountability, and ethical behavior.
Safety
Promotes and maintains a safe environment for patients, visitors, and colleagues.
Role Model
Serves as a dependable representative of Sinai Chicago's mission and values.
Sinai Chicago is an Equal Opportunity Employer committed to fostering a diverse, equitable, and inclusive workplace.

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About Sinai Chicago

Sourced by ZipRecruiter

Sinai Chicago is an integral part of the healthcare industry, established to provide quality and accessible healthcare for the Chicago, IL, US community. The organization operates across various healthcare sectors including teaching, research, and providing clinical care. Since its inception in 1919, Sinai Chicago has been resolute in improving the health of the people and communities it serves, with a focus on delivering value-based care to areas with pressing health needs. The core values of Sinai Chicago include respect, integrity, teamwork, accountability, and quality. The company's mission and commitment lie in nurturing healthier communities through the provision of accessible, quality healthcare.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Chicago, IL, US

Year founded

1919

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