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Utilization Review Jobs in Kansas (NOW HIRING)

KVC Health Systems

Medical Coding Specialist

Mission, KS · On-site

This role will collaborate with the medical providers, Utilization Review Department, and Accounts Receivable Department to ensure all legal requirements regarding coding procedures and practices are ...

New

US Tech Solutions

Registered Nurse

Wichita, KS · On-site

MUST HAVE UM experience, inpatient utilization management review. * MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. * MUST HAVE 6 months of Prior Authorization.

Wellpath

Medical Director

Kansas City, KS · On-site

Oversee chronic care clinics, utilization review, and quality improvement initiatives * Collaborate with the Health Services Administrator to enhance patient care and outcomes * Maintain clinical ...

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Utilization Review information

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$19

$37

$61

How much do utilization review jobs pay per hour?

As of Aug 4, 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.

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 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 July 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.

RN Case Manager - Behavioral Health Utilization Review

MLee Medical Employment

Goddard, KS • On-site

Other

Re-posted 4 days ago

Job description

Join a dedicated healthcare team in the Midwest region as a Registered Nurse Case Manager specializing in behavioral health utilization review. In this role, you will collaborate closely with healthcare providers and members to evaluate patient needs and benefit requirements, ensuring optimal resource use. You will manage patient cases within the behavioral health unit, reviewing medical necessity for admissions, continued stays, and services.
Essential Responsibilities:

  • Assess patient situations and conduct reviews to ensure compliance with eligibility, benefits, policies, and contracts.
  • Manage appeals and coordinate comprehensive reviews of medical records to verify accurate admission and diagnosis information.
  • Promote improved quality of care and support reduced hospital stays when safe and appropriate.
  • Advise pre-certification staff and maintain records and reports related to non-clinical activities.
  • Coordinate with insurance companies to secure authorizations for behavioral health services, ensuring adherence to payer requirements and facility standards.
  • Maintain thorough documentation of utilization review activities, including clinical justifications and authorization requests.
  • Assist with triage screenings for incoming behavioral health patients to determine immediate care needs and facilitate timely care delivery.
  • Provide psychosocial support to patients and families, addressing emotional, social, and financial barriers.
  • Serve as a liaison between healthcare teams and patients/families to ensure smooth care transitions.
  • Support discharge planning processes when needed, ensuring safe and appropriate discharge plans.
  • Conduct safety assessments and make protective reports for adults and children as indicated.
  • Participate in ongoing professional development and mandatory training, including de-escalation techniques.
  • Adhere to privacy and security regulations regarding Protected Health Information (PHI).
  • Maintain effective communication and professional relationships with patients, team members, physicians, and external agencies.
Education and Experience:
  • Graduate of a nursing or Bachelor of Social Work (BSW) program.
  • Experience in behavioral health settings, particularly crisis management and inpatient care.
Licenses and Certifications:
  • Current licensure as a Registered Nurse (RN) or BSW in the relevant state.
  • Current Basic Life Support (BLS) certification from American Heart Association or American Red Cross within 30 days of hire.
  • De-escalation training required within six months of start date.
Preferred Qualifications:
  • Experience in utilization review, insurance coordination, and interdisciplinary team collaboration.
  • Advanced degrees such as BSN or MSW are a plus.
Skills and Abilities:
  • Strong collaboration skills with interdisciplinary teams to ensure high-quality care.
  • Familiarity with community resources, mental health services, and post-acute care.
  • Basic computer proficiency and experience documenting in electronic health records.
  • Ability to multitask, prioritize, and communicate effectively.

Physical Requirements: Medium work involving occasional exertion up to 50 lbs and frequent standing or walking (26-50% of the day).
This position offers a competitive salary and benefits package, providing a meaningful opportunity to impact behavioral health care in a supportive regional healthcare environment.

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