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Utilization Review Jobs in Hawaii (NOW HIRING)

AlohaCare

Medical Director

Honolulu, HI · On-site

Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality ...

AlohaCare

Medical Director

Honolulu, HI · On-site

$110 - $135/hr

Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality ...

AlohaCare

Medical Director

Honolulu, HI

Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality ...

AlohaCare

Medical Director

Honolulu, HI · On-site

$151.54 - $185.98/hr

Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality ...

AlohaCare

Medical Director

Honolulu, HI · On-site

Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality ...

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All JobsUtilization Review JobsUtilization Review Jobs in Hawaii

Utilization Review information

See Hawaii salary details

$22

$43

$71

How much do utilization review jobs pay per hour?

As of Aug 25, 2026, the average hourly pay for utilization review in Hawaii is $43.93, according to ZipRecruiter salary data. Most workers in this role earn between $34.71 and $50.43 per hour, depending on experience, location, and employer.

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 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.

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, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

What are the most commonly searched types of Utilization Review jobs in Hawaii?

The most popular types of Utilization Review jobs in Hawaii are:

What are popular job titles related to Utilization Review jobs in Hawaii?

For Utilization Review jobs in Hawaii, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Hawaii look for?

The top searched job categories for Utilization Review jobs in Hawaii are:

What cities in Hawaii are hiring for Utilization Review jobs?

Cities in Hawaii with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Hawaii as of August 2026, with employment types broken down into 100% Full Time. Highlights an 92% In-person, and 8% Hybrid job distribution, with an average salary of $91,373 per year, or $43.9 per hour.

Concurrent Nurse Reviewer - Facility Utilization Review Unit

Honolulu, HI • On-site

HMSA
Insurance Services • 1 - 5K employees
Learn more about HMSAexternal

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

  1. Applies appropriate medical necessity criteria from established medical policies and clinical practice guidelines to apply concurrent review determinations as described in the Medical Management UM work plan.
    • This detailed clinical judgment includes determination of inpatient hospital stays as medically appropriate for the member's clinical condition or whether the stay requires referral to a Medical Director for potential denial.
    • The Nurse Reviewer must follow each line of business requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each inpatient admission.
    • Responsibilities include using effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to:
      • Promote improved quality of care and/or life
      • Promote cost effective medical outcomes
      • Prevent hospitalization when possible and appropriate
      • Promote decreased lengths of hospital stays when appropriate
      • Ensure the quality-of-care member is receiving during hospital stay is appropriate
      • Ensure appropriate levels of care are received by patients
      • Consult with Medical Directors on potential quality issues encountered during review of medical records in situations when the complexity of the member's medical, surgical and/or pharmaceutical management is unclear and may require further review or intervention and follow up with attending physicians, hospitalists, or other facility staff
  2. Provide appropriate consultation and referral to Case Management or QUEST Integration program as appropriate
  3. Identify appropriate alternative and non-traditional resources and demonstrate creativity in managing each case to fully utilize all available inpatient and community resources.
  4. Identifies cost savings and accurately records all communications and interventions.
  5. Evaluates suspended claims against medical records to determine the medical necessity and appropriateness of medical services, identify irregularities such as over or under-utilization of services, potential up-coding, over billing, etc.
  6. Communicates timely, accurate information either verbally or in writing using clinical judgment, knowledge of medical/reimbursement policies and plan benefits to internal MM staff, other internal departments (Claims Administration, Customer Relations, etc.), providers, members, and other authorized persons.
    • For denied services, ensures the denial, benefit and appeal language are accurate and consistent with department procedures, accreditation, and regulatory guidelines.
  7. Identifies and refers members with specific medical and/or behavioral health needs or complex case management and collaborates with case management staff as needed. Also identifies and refers quality of care issues and suspected fraud, waste, or abuse to the appropriate departments.
  8. Performs all other miscellaneous responsibilities and duties as assigned or directed.
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