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Utilization Review Jobs in Kansas (NOW HIRING)

CVS Health

Utilization Management Nurse Consultant

Home, KS · On-site

$26.01 - $68.55/hr

Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities ...

MLee Medical Employment

RN - Care Manager

Alden, KS · On-site

Perform utilization reviews for all patients and assist nursing staff with patient care as needed. * Support rehabilitation training and education for staff when required. * Ensure compliance with ...

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How much do utilization review jobs pay per hour?

As of Aug 25, 2026, the average hourly pay for utilization review in Kansas is $37.71, according to ZipRecruiter salary data. Most workers in this role earn between $29.81 and $43.32 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 Kansas?

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

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

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

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

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

What cities in Kansas are hiring for Utilization Review jobs?

Cities in Kansas with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Kansas as of August 2026, with employment types broken down into 50% Full Time, and 50% Contract. Highlights an 100% In-person job distribution, with an average salary of $78,435 per year, or $37.7 per hour.

Utilization Reviewer

Lawrence, KS • On-site

Bert Nash Community Mental Health Center
Offices of Mental Health Practitioners • 51 - 200 employees

6.2

Company rating: 6.2 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

Learn more about Bert Nash Community Mental Health Centerexternal

$65K - $70K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 3 days ago

Job description

Utilization Reviewer
Pay is commensurate with experience within a range of $65,000 to $70,000 annually. Full time, exempt, benefits eligible. Bert Nash offers excellent benefits which include medical, dental, vision, KPERS retirement, life insurance, an Employee Assistance Program (EAP) providing free counseling and resources, and generous PTO.
Caring. Hope. Giving back. Our mission at the Bert Nash Center as the Community Mental Health Center (CMHC) of Douglas County is to advance the health of the community through comprehensive behavioral health services responsive to evolving needs and changing environments. We accomplish this by believing in our team. Each person that works for the Bert Nash Center contributes directly to the success of our clients, organization, and community. Our values of compassion, integrity, equity and hope reflect in everything we do.
The Utilization Reviewer's primary responsibility is to manage and complete monthly clinical record reviews to ensure provision of clinically appropriate care is delivered to clients in the least restrictive but clinically appropriate level as quickly as possible while complying with agency, payers, applicable policies, regulations and accreditation standards. This role's overall goal is to ensure that quality services are provided in the most efficient, cost-effective manner to all eligible clients seeking treatment regardless of the treatment setting or payer.
Responsibilities: The primary responsibility of the Utilization Reviewer is to ensure clinical documentation achieves expected standards, implement and train for consistency in best practices across the organization's facilities, participate and coordinate with teams Quality Improvement Plans or related initiatives. Duties will include but not limited to:
  • Conduct monthly clinical chart reviews to assure clients receive clinically appropriate care and complies with agency, payor, applicable policies, regulations and accreditation standards.
  • Utilize evidence-based calculation to ensure the sample size of charts reviewed provide a high confidence level that results are valid and reliable.
  • Provide chart review results to program directors or managers with both aggregate program data and individual charts needing remediation.
  • Work with directors or program managers on remediation activities to ensure they are completed within 30 days.
  • Meet with teams to help identify and develop continuous quality improvement goal(s) to improve the quality of documentation.
  • Managing organizational risks through implementation and improvement of best practices in clinical documentation, CCBHC regulations, CARF standards and other regulatory requirements.
  • Provide or coordinate the provision of related trainings in collaboration with the Clinical Consultant, Clinical Educator, and other team members.
  • Provides response to clinical quality questions.
  • Champions continuous quality improvement and assists in developing, tracking, and realizing related organizational goals or objectives.
  • Assign, analyze and present the quarterly chart review data for all teams per CARF Standards 2.G. and 2.H.
  • Analyzes monthly chart reviews to identify both areas needing improvement and areas that have improved since previous audits.
  • Maintain and record inventories of chart review occurrences and results.
Qualifications include but not limited to:
  • Licensure in social work, counseling, nursing or psychology.
  • Knowledge and familiarity with electronic health record (EHR) documentation.
  • Three years of experience providing billed services to clients in fields such as nursing, counseling, psychology, therapy, medication management, case management, or other.
  • Master's degree in behavioral health, medical services or administration, nursing, psychology, sociology, or similar.
  • Ability to accurately interpret standards from policies, contracts, and accrediting bodies for implementation.
  • Flexibility in assigned working hours.
  • Ability to negotiate, complete contracted work, analyze operations, and governmental/accrediting body regulations.
  • Interest or experience in quality improvement, quality assurance, or similar background and/or training a plus.
  • Have exemplary existing skills in clinical documentation and familiarity with using EHRs to complete documentation reviews, as well as external tools such as the Microsoft Office Suite.
  • Assist QI team with other duties as needed.

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