ZipRecruiter

Log In

1

Utilization Review Jobs in Puerto Rico (NOW HIRING)

Pacs

$70K - $85K/yr

Performs utilization review activities to provide resident appropriate, timely and cost-effective care. * Coordinate care with resident, care providers, facilities financial services, and third-party ...

Encompass Health

Case Manager

Manati, PR

$17 - $21.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Case Manager

Manati, PR

$17 - $21.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

OncoHealth

Case Review Specialist - PR

Guaynabo, PR · On-site +1

About the Role The Case Review Specialist ensures that case documentation is provided by the ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...

OncoHealth

Case Review Specialist - PR

Guaynabo, PR · On-site

About the Role The Case Review Specialist ensures that case documentation is provided by the ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...

UHS

PR

Provide backup to Utilization Review Department out of business hours including document in the appropriate platform services request, provide information of service request status, provide ...

Weil Group, Inc

Assistant to Operations

Manati, PR · On-site

... up safety reviews and communication of changes across departments. Responsible for maintaining the Operating Asset Utilization (OAU) data for assigned process. Provide operator and supervisor ...

Weil Group, Inc.

Assistant to Operations

Manati, PR · On-site

... reviews and communication of changes across departments. • Responsible for maintaining the Operating Asset Utilization (OAU) data for assigned process. • Provide operator and supervisor training ...

Weil Group, Inc

PR · On-site

... reviews and communication of changes across departments. • Responsible for maintaining the Operating Asset Utilization (OAU) data for assigned process. • Provide operator and supervisor training ...

SOLX HOLDINGS LLC

PR · On-site

Review production orders and adjust schedules as needed to meet operational priorities and delivery commitments. * Analyze production capacity, manpower, and machine utilization to optimize workflow ...

CooperCompanies

Planner

Juana Diaz, PR · On-site

Day to day capacity utilization Supply Chain advice * Assuring Compliance with Laws & Regulations ... Reviewing shortage materials with suppliers * Material procurement packaging design * Providing ...

Master Fluid Solutions

$12.75 - $16.50/hr

Process incoming purchase orders through shipment in the ERP system ensuring review and accuracy of ... utilization Planning: Determine proper stocking levels and set Min/Max and safety stocks ...

Cooper Companies

Planner

Juana Diaz, PR

Day to day capacity utilization Supply Chain advice * Assuring Compliance with Laws & Regulations ... Reviewing shortage materials with suppliers * Material procurement packaging design * Providing ...

next page

Showing results 1-20

All JobsUtilization Review JobsUtilization Review Jobs in Puerto Rico

Utilization Review information

What jobs pay $10,000 a month without a degree?

Utilization Review roles typically do not pay $10,000 a month without relevant experience or certifications; most positions in this field pay lower salaries. High-paying jobs that can reach this level without a degree often include specialized sales, real estate, or entrepreneurship, but they usually require significant skills, networking, or business acumen. Achieving such income without a degree generally involves gaining expertise, certifications, or building a successful independent business.

What does a typical day look like for someone working in Utilization Review?

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 skills do you need for utilization review?

Utilization review professionals need strong analytical skills to assess medical necessity and appropriateness of care, attention to detail, and knowledge of healthcare regulations and insurance policies. Good communication skills are essential for coordinating with healthcare providers and explaining decisions. Familiarity with electronic health records (EHR) systems and relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can also be beneficial.

What is a Utilization Review job?

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 the Utilization Review position, and why are they important?

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.

What is the least stressful healthcare job?

Utilization review is often considered a less stressful healthcare job because it typically involves reviewing medical cases and insurance claims in a predictable, office-based environment. It usually requires strong analytical skills and certification but involves less direct patient interaction and emergency situations compared to clinical roles.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare professional such as a registered nurse, licensed social worker, or physician completes relevant education and obtains certification in utilization review or case management. Gaining experience in healthcare settings and understanding insurance policies and medical coding can also improve job prospects. Certification programs like the Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM) are often preferred by employers.
What are the most commonly searched types of Utilization Review jobs in Puerto Rico? The most popular types of Utilization Review jobs in Puerto Rico are:
What are popular job titles related to Utilization Review jobs in Puerto Rico? For Utilization Review jobs in Puerto Rico, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Puerto Rico look for? The top searched job categories for Utilization Review jobs in Puerto Rico are:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Puerto Rico as of June 2026, with employment types broken down into 100% Full Time. Highlights an 60% In-person, and 40% Remote job distribution.

Pharmacist - Federal Detention Center, Guaynabo PR

CLFC Healthcare and Communications

Guaynabo, PR • On-site

$130K - $165K/yr

Full-time

Medical, Dental, Vision, PTO

Posted 4 days ago

Job description

Position Overview

CLFC Healthcare & Communications is seeking a Pharmacist to manage pharmaceutical services at a federal metropolitan detention center in Guaynabo, Puerto Rico. You will oversee medication dispensing, formulary management, drug utilization review, and clinical pharmacy services for the incarcerated population, ensuring compliance with Bureau of Prisons pharmacy standards and DEA controlled substance regulations.

Key Responsibilities
  • Dispense prescription medications accurately and counsel providers on drug interactions, dosing adjustments, and formulary alternatives
  • Manage controlled substance inventory with precise documentation, count verification, and DEA compliance
  • Conduct drug utilization reviews and monitor for therapeutic appropriateness, contraindications, and adverse reactions
  • Maintain pharmaceutical inventory, manage drug procurement, and ensure proper storage conditions
  • Prepare and compound medications as required by facility clinical protocols
  • Provide clinical pharmacy consultations to physicians and mid-level providers
  • Participate in pharmacy and therapeutics committee activities
  • Supervise pharmacy technicians and support staff
  • Maintain compliance with BOP pharmacy policies, state Board of Pharmacy regulations, and Joint Commission standards
Required Qualifications
  • Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy
  • Active, unrestricted pharmacist license in Puerto Rico or any U.S. state
  • Current BLS certification
  • Minimum 1 year of pharmacy practice experience
  • U.S. citizenship required
  • Ability to pass federal background investigation
Preferred Qualifications
  • Bilingual English/Spanish proficiency
  • Institutional or correctional pharmacy experience
  • Board Certified Pharmacotherapy Specialist (BCPS) or equivalent
Compensation and Benefits
  • Salary: $130,000 - $165,000 annually
  • Comprehensive health, dental, and vision insurance
  • Paid time off, holiday pay, malpractice coverage
  • Professional development and CE support
About CLFC Healthcare & Communications

CLFC Healthcare & Communications provides healthcare staffing and language access services to federal, state, and local government agencies nationwide. With 500+ healthcare professionals and 200+ interpreters, CLFC delivers reliable workforce solutions. Equal Opportunity Employer.