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Utilization Review Jobs in Kentucky (NOW HIRING)

Med Center Health

Insurance Specialist

Bowling Green, KY · On-site

$11.55/hr

Verifies and assigns appropriate insurance mnemonics and information obtained into Meditech for use by Utilization Review personnel. * Monitors the status of patient's insurance coverage and refers ...

Med Center Health

Insurance Specialist

Bowling Green, KY · On-site

$11.55/hr

Verifies and assigns appropriate insurance mnemonics and information obtained into Meditech for use by Utilization Review personnel. * Monitors the status of patient's insurance coverage and refers ...

Graves Gilbert Clinic

PHARMACIST

Bowling Green, KY

$57 - $68.50/hr

The pharmacist conducts cost analyses and financial evaluations of therapies, assisting in formulary management, drug utilization review, and strategic purchasing decisions to promote both clinical ...

Graves Gilbert Clinic

PHARMACIST

Bowling Green, KY · On-site

$57 - $68.50/hr

Conduct drug utilization reviews and ensure adherence to formulary guidelines and evidence-based practices. * Perform cost analyses, reimbursement evaluations, and financial assessments to support ...

Wellpath

Medical Director

Eddyville, KY

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

First Connect Health

RN - Home Health

Bardstown, KY · On-site

Pediatrics and adults Additional Job Duties / Utilization Review Involved? No Do you use a point system? How many points per day/week? Do you require travelers to complete Start of Care, recerts, and ...

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All JobsUtilization Review JobsUtilization Review Jobs in Kentucky

Utilization Review information

See Kentucky salary details

$18

$36

$59

How much do utilization review jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for utilization review in Kentucky is $36.72, according to ZipRecruiter salary data. Most workers in this role earn between $29.04 and $42.16 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 Kentucky? The most popular types of Utilization Review jobs in Kentucky are:
What are popular job titles related to Utilization Review jobs in Kentucky? For Utilization Review jobs in Kentucky, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Kentucky look for? The top searched job categories for Utilization Review jobs in Kentucky are:
What cities in Kentucky are hiring for Utilization Review jobs? Cities in Kentucky with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Kentucky as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, and 5% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $76,384 per year, or $36.7 per hour.

Manager, Care Management Clinical Effectiveness

North Healthcare

Louisville, KY • On-site

$62K - $86K/yr

Other

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

Job description

Mgr, Care Mgmt Clin Effect

In collaboration with the leader, the Mgr, Care Mgmt Clin Effect manages a team of professional staff responsible for providing care management services while ensuring patients receive cost-effective, high quality, and safe care. This includes, but is not limited to, care coordination, discharge planning, medical necessity reviews, and psycho-social services. The manager also works in collaboration with key stakeholders to drive initiatives that support quality services across the care continuum, such as reducing length of stay and preventable readmissions.

Key Accountabilities:

  • Works in collaboration with the department director to achieve Norton, as well as departmental, goals and objectives.
  • Facilitates the achievement of the annual care management budget and performance metrics developed collaboratively with leadership.
  • Responsible for daily operations. Mentors staff through the coordination of orientation, ongoing coaching/education, and performance evaluation. Oversees staffing productivity schedules to ensure the effective utilization of facility care management staff. Provides direction/guidance in patient care management related issues.
  • Leads formal groups in rapid-cycle and performance improvement activities.
  • Partners with various stakeholders to maintain and improve quality of care and patient satisfaction. Provides care management functions within a patient care assignment as appropriate.

Qualifications:

  • Three years clinical experience in medical surgical, or critical care nursing and One year care management experience
  • Bachelor Degree
  • Registered Nurse

Desired:

  • Three years in utilization review or case management
  • Master Degree
  • Accredited Case Manager OR Certified Case Manager

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