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Utilization Review Jobs in Kentucky (NOW HIRING)

Graves Gilbert Clinic

PHARMACIST

Bowling Green, KY · On-site

$56.75 - $68.25/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 ...

Dinsmore & Shohl

Nurse Consultant

Louisville, KY · On-site

Minimum 5 years of clinical nursing experience (critical care, ER, utilization review, or case management experience preferred) * Prior legal nurse consulting or litigation support experience ...

Covelo Direct LLC

Medical Director

Louisville, KY

Experience with quality management, utilization review, peer review, credentialing, and performance improvement * PACE, geriatrics, Medicare Advantage, managed care, SNF, or value-based care ...

UHS

DISCHARGE PLANNER

Louisville, KY · On-site

Works with Utilization Review to establish prior authorization, travel, insurance application, etc. is coordinated for a timely discharge. * Maintains a shared file where information is updated to ...

Breckinridge Health Inc

ACTIVITIES ASSISTANT

Hardinsburg, KY · On-site

$13 - $15.50/hr

Participate in performance improvement and utilization review programs * Maintain daily record of activities * Complete activity and social services assessment on all admissions along with the MDS ...

Dinsmore

Nurse Consultant

Louisville, KY · On-site

Minimum 5 years of clinical nursing experience (critical care, ER, utilization review, or case management experience preferred) * Prior legal nurse consulting or litigation support experience ...

Dinsmore Inc

Nurse Consultant

Louisville, KY · On-site

Minimum 5 years of clinical nursing experience (critical care, ER, utilization review, or case management experience preferred) * Prior legal nurse consulting or litigation support experience ...

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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.

Medical Director - MD - Physician - Days

Wellpath / Correct Care Solutions

Lexington, KY • On-site

$286.42 - $318.24/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted yesterday

Job description

Medical Director – MD – Physician – Days

Compensation: $286,416 - $318,240 per year

Department (Org): Medical

Responsibilities
  • Provide direct medical care and document all clinical encounters in compliance with standards.
  • Supervise and support healthcare staff and ensure adherence to clinical protocols.
  • Oversee chronic care clinics, utilization review, and quality improvement initiatives.
  • Collaborate with the Health Services Administrator to enhance patient care and outcomes.
  • Maintain clinical oversight and consult on complex medical cases or referrals.
Qualifications & Requirements
  • Education: Medical school graduate.
  • Experience: Preferred experience in Family Practice, Emergency Medicine, Internal Medicine, or Public Health.
  • Licenses/Certifications: Must have and maintain current licensure within the state of employment; maintain a current DEA number; obtain and maintain CPR certification; maintain privileges and CME requirements for continued medical practice in the state.

-This is a full-time/day shift position.

Benefits
  • Comprehensive benefits including medical, dental, vision, paid time off, and 401(k).
  • DailyPay – receive earnings as you earn.
  • Tuition Assistance and dependent scholarships.
  • Employee Assistance Program (EAP) with free counseling and health coaching.
  • Company‑paid life insurance.
  • Tax‑free Health Spending Account (HSA).
  • Wellness program featuring fitness memberships and product discounts.
  • Preferred banking partnership and discounted rates for home and auto loans.

*Eligibility for perks and benefits varies based on employee type and length of service.

Equal Employment Opportunity

We celebrate diversity and are committed to creating an inclusive environment for all employees.

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