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Utilization Review Jobs in Missouri (NOW HIRING)

NHC

LPN Admissions Coordinator (weekends only)

Osage Beach, MO · On-site

$24.75 - $32.75/hr

Utilization Review and insurance authorization preferred. * Prefer one-year experience working in a similar position, or one year of clinical experience with the primary population served by the ...

Liberty Dental Plan

Senior Staff Dentist

California, MO · On-site

$175 - $185/hr

ResponsibilitiesClinical Review & Utilization Management * Review dental claims, referrals, and prior authorization requests to ensure medical necessity and regulatory compliance * Interpret dental ...

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How much do utilization review jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for utilization review in Missouri is $39.66, according to ZipRecruiter salary data. Most workers in this role earn between $31.35 and $45.53 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 Missouri? The most popular types of Utilization Review jobs in Missouri are:
What are popular job titles related to Utilization Review jobs in Missouri? For Utilization Review jobs in Missouri, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Missouri look for? The top searched job categories for Utilization Review jobs in Missouri are:
What cities in Missouri are hiring for Utilization Review jobs? Cities in Missouri with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Missouri as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, and 5% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $82,494 per year, or $39.7 per hour.

Case Manager - RN

Missouri Delta Medical Center

Sikeston, MO • On-site

Full-time

Re-posted 16 hours ago

Missouri Delta Medical Center rating

6.0

Company rating: 6.0 out of 10

Based on 15 frontline employees who took The Breakroom Quiz

868th of 1,055 rated hospitals

Job description

FUNCTIONS OF POSITION:

1. Performs admission, concurrent and focused reviews using severity of illness/intensity of service criteria to ensure effective utilization management.

2. Refers unjustified cases to physician advisor following hospital U.R. plan.

3. Collects and analyzes data to assure that quality and cost effectiveness issues are addressed for enhancement of patient care and Q.I./R.M./U.R. activities.

4. Maintains daily and monthly work log and/or abstracts on all reviews to ensure appropriateness of utilization review activities.

5. Prepares reports, graphs, and statistical data for reporting thru committee structures.

6. Collaborates with physicians, nurses, and other health care personnel to ensure effective utilization management.

7. Communicates with state PRO, insurance companies and other third party organizations to ensure appropriate utilization of resources.

QUALIFICATIONS:

EDUCATION: Graduate of accredited ADN or BSN program.

LICENSE: Possess current license by Missouri State Board of Nursing.

CREDENTIALS: Registered Nurse.

EXPERIENCE: Experience in case management preferred or two (2) years clinical experience in related field preferred.

SPECIAL:

PATIENT CONTACT: Must have the knowledge and skills necessary to provide care appropriate to the age of the patients served.

TYPING: Minimal

MACHINE OPERATION: Computer for entry or retrieval of data, 10 key calculator, copy machine, typewriter.

PHYSICAL:

STANDING: Minimal periods, but must be able to sit for long periods of time for reviewing of charts.

WALKING: Must be able to walk quickly to all areas of the hospital and occasionally to physician offices

LIFTING: Minimal - light loads (no more than 15 lbs)

VISUAL: Must have good acuity to review medical records, occurrence forms, computer screens, manuals, and other tools used in job performance

HEARING: Audio reception essential for effective understanding and communication with hospital staff and outside agencies

SPEAKING: Must have the ability to orally speak for effective communication with hospital staff and outside agencies


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