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Utilization Review information

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$38

$62

How much do utilization review jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for utilization review in Alabama is $38.32, according to ZipRecruiter salary data. Most workers in this role earn between $30.29 and $43.99 per hour, depending on experience, location, and employer.

Is utilization review work from home?

Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.
What are the most commonly searched types of Utilization Review jobs in Alabama? The most popular types of Utilization Review jobs in Alabama are:
What are popular job titles related to Utilization Review jobs in Alabama? For Utilization Review jobs in Alabama, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Alabama look for? The top searched job categories for Utilization Review jobs in Alabama are:
What cities in Alabama are hiring for Utilization Review jobs? Cities in Alabama with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Alabama as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $79,714 per year, or $38.3 per hour.

Utilization Review Care Manager

DCH Health System

Tuscaloosa, AL • On-site

Full-time

Re-posted 16 days ago

DCH Health System rating

7.0

Company rating: 7.0 out of 10

Based on 19 frontline employees who took The Breakroom Quiz

Job description

Overview
Evaluates patients for appropriateness of admission type and setting, utilizing a combination of clinical information and InterQual guidelines. The Utilization Review Nurse utilizes clinical knowledge to support the coordination and documentation and communication of medical services and/or benefits. The Utilization Nurse also serves on the liaison between the physicians, patients, payers and care managers regarding termination of benefits, denial notification, and expedited appeals. Has access to highly sensitive, confidential information.
Responsibilities
  1. Evaluates medical records for appropriateness of admission status utilizing a combination of clinical information, screening criteria, and third party information. Collaborates with business office, care managers, attending physicians, and physician advisors as needed
  2. Conducts self-auditing of medical records for status accuracy and provides peer consultation regarding cases in which patients are failing to progress and/or experiencing significant deviation from the plan of care.
  3. Educates staff and physicians about managed care principles, observation status, discharge planning, and reimbursement rules.
  4. Works with Patient Registration\Financial Counselor (s) to identify correct insurance source and proper billing.
  5. Verifies patient admission information for each assigned patient within 24 hours of patient's admission (next business day)
  6. Collaborates with the Case Manager to identify referrals to Financial Counselors.
  7. Negotiates resolution disagreements over the need for acute hospital level of care with the insurer.
  8. Collaborates with social workers for patients with complex, clinical, financial and psycho-social needs.
  9. Reviews physician orders and patient progression and intervenes with care coordination as needed. Collaborates with other departments to eliminate barriers, as necessary.
  10. Builds trusting relationships with attending physician, patient and/or family and other members of the healthcare team. Establishes a caring relationship with patients and their caregivers, promotes patient engagement and guides patients/families through the transition phase
  11. In accordance with established clinical guidelines/standards of care establishes a comprehensive care transition plan and will organize, secure, integrate and modify resources necessary to meet the goals stated in the assessment plan.
  12. Identifies Potential Avoidable Days per department policy.
  13. Gathers information for statistical monitors, plus special projects within the Care Management Department.
  14. Maintains records in a complete, detailed, and orderly manner.
  15. Updates and documents in Midas, pertinent clinical information by utilizing screening criteria and assigns next review date.
  16. Responsible to support and participate in department strategies and efforts focused on improving length of stay (LOS) and reduction of avoidable readmissions.
  17. Responsible to support and participate in department strategies and efforts focused on improving clinical documentation by physicians.
  18. Is knowledgeable of hospital mission, vision, and values and performs in a manner to support them.
  19. Identifies and reports Quality and Risk Management concerns.

DCH Standards:
  • Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
  • Performs compliance requirements as outlined in the Employee Handbook.
  • Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
  • Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
  • Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
  • Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
  • Requires use of electronic mail, time and attendance software, learning management software and intranet.
  • Must adhere to all DCH Health System policies and procedures.
  • All other duties as assigned.

Qualifications
  1. Anyone hired after July, 2011 must meet the following:
  2. Minimum of Registered Nurse with current Alabama license.
  3. Minimum 2 years experience as an RN
  4. Minimum of at least 2 years as care management and/or utilization management experience preferred.
  5. Minimum of 2 years of Med Surgical experience required; Utilization Review experience preferred.
  6. Expected to work under minimal management supervision
  7. Efficient use of basic computer skills
  8. Ability to multi task, prioritize and effectively adapt to a fast paced changing environment
  9. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the phone and typing on the computer.
  10. Work requires the ability to perform close inspection of computer generated documents as well as a PC monitor.
  11. Typical office working environment with productivity and quality expectations.
  12. Ability to establish priorities, meets deadlines, and maintains proper productivity.
  13. Ability to form positive, collaborative relationships with hospital staff, patients, families and payers.
  14. Ability to problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge.
  15. Ability to effectively negotiate with internal and external providers of patient care services.
  16. Ability to develop leadership skills and to serve as a role model for clinical staff.
  17. Ability to lead and actively participate in multidisciplinary teams.
  18. Ability to work independently or within a team structure.
  19. Excellent interpersonal skills, communication style and organization.
  20. Must be able to read, write legibly, speak, and comprehend English.

Working Conditions:
WORK CONTEXT
  • Ability to form positive, collaborative relationships with physicians, colleagues, hospital staff, patients, families, and external contacts.
  • Ability to provide guidance and direction to subordinates, including performance standards and monitoring performance.
  • Ability to encourage and build mutual trust, respect, and cooperation among team members.
  • Ability to communicate with people outside the organization and represent the organization to the public, government, and other external sources.
  • Ability to work independently or within a team structure.
  • May be exposed to environmental cleaning chemicals

PHYSICAL FACTORS
  • Requires Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
  • Ability to tolerate prolonged periods of sitting or standing and/or walking.
  • Ability to reach reasonable distances to handle equipment.
  • Good manual and finger dexterity.
  • Must be able to perform the duties with or without reasonable accommodation.
  • Hearing and vision must be normal or corrected to within normal range.
  • Physical presence onsite is essential.

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