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Utilization Review Jobs in Hawaii (NOW HIRING)

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

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 ...

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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 Jul 28, 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 jobs make $3,000 a day?

High-paying jobs that can reach $3,000 a day include specialized roles such as senior physicians, anesthesiologists, or surgeons, often requiring advanced certifications and extensive experience. Certain executive positions, like CEOs or investment bankers, may also earn this level of daily income, especially through bonuses or profit sharing. These roles typically involve high responsibility, expertise, and demanding schedules.

What jobs pay 4000 a week without a degree?

Utilization Review specialists typically do not earn $4,000 per week without a degree; most roles in this field require healthcare-related certifications or experience. High-paying jobs that can reach this level without a degree include certain sales positions, real estate brokers, or specialized trades like commercial pilots or skilled trades, which often rely on experience, licensing, or certifications rather than formal degrees. These roles may involve commission, bonuses, or overtime to achieve such weekly earnings.

What does a typical day look like for someone working in Utilization Review?

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 skills do you need for utilization review?

Utilization review professionals need strong analytical skills to assess medical necessity and appropriateness of care, attention to detail, and knowledge of healthcare regulations and insurance policies. Good communication skills are essential for coordinating with healthcare providers and explaining decisions. Familiarity with electronic health records (EHR) systems and relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can also be beneficial.

What is a Utilization Review job?

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 the Utilization Review position, and why are they important?

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 professional such as a registered nurse, licensed social worker, or physician completes relevant education and gains experience in healthcare or insurance. Certification in utilization review or case management, such as the Certified Professional in Healthcare Quality (CPHQ), can improve job prospects. Strong analytical skills and knowledge of medical coding and insurance policies are also important.
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 July 2026, with employment types broken down into 93% Full Time, 5% Part Time, and 2% Temporary. Highlights an 85% In-person, 5% Hybrid, and 10% Remote job distribution, with an average salary of $91,373 per year, or $43.9 per hour.
Utilization Reviewer (Applied Behavior Analysis)

Utilization Reviewer (Applied Behavior Analysis)

Hawaii Medical Service Association

Honolulu, HI • Hybrid

Full-time

Posted 10 days ago

Job description

  1. Applies appropriate medical necessity criteria for Applied Behavior Analysis from an established medical policy and clinical guidelines to render pre- or post-service clinical decisions as described in the Medical Management UM work plan. This detailed analysis includes evaluating the care of members with autism spectrum disorder to determine medical necessity and benefit coverage applicable for all HMSA medical plans and contracted government programs. Responsibilities include, but are not limited to:
    • Demonstrating understanding and application of clinical review criteria, decision rules, medical protocols and other criteria to determine the appropriateness of Applied Behavior Analysis.
    • Documenting care summaries and outcomes of reviews appropriately to meet regulatory and program requirements.
    • Consulting with Medical Directors on issues encountered during review of medical records in situations when the complexity of the member's management is unclear; there is a potential denial of services; or a potential for reducing the services requested.
  2. Evaluates suspended claims against medical records to determine the medical necessity and appropriateness of certain ABA services, frequency patterns and irregularities in billing. Irregularities may include up coding, over billing, etc.
  3. Communicates timely, accurate information either verbally or in writing using knowledge of medical/reimbursement policies, plan benefits and clinical judgment to internal MM staff, 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.
  4. Identifies and refers members with specific medical and/or behavioral health needs or complex case management and collaborates with case management staff as needed.
  5. Identifies and refers quality of care issues and suspected fraud, waste or abuse to the appropriate department.
  6. Participates in meetings and program design and improvement activities with the HMSA Behavioral Health Team.
  7. Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
  1. Bachelor's degree and five years related work experience; or equivalent combination of education and work experience.
  2. Knowledge of the appropriate protocol to be followed for a given diagnosis and the normative values of medical tests and procedures.
  3. Good typing skills with low error rate.
  4. Basic working knowledge of Microsoft Office applications includes Outlook, Word, and Excel.
  5. Must have valid driver's license, access to an automobile with current license, registration and no-fault insurance. Requires safely operating an insured automobile for travel to off-site locations to conduct and accomplish business related activities.
  6. Currently licensed in Hawaii as a Board-Certified Behavior Analyst.

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