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Utilization Review Jobs in Puerto Rico (NOW HIRING)

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 ...

LifeLink

Remote Administrator on Call PR

Guaynabo, PR · On-site +1

  • Medical

  • Dental

  • Life

  • Retirement

  • PTO

Works closely with the Referral Coordinator (RC) in the utilization of available staff and ... Engages in review, education, and required organizational meetings to promote best practice sharing ...

Pharmpix

PR · On-site

Investigate and resolve discrepancies related to utilization, eligibility, or payment amounts ... Compile documentation requested during internal or external reviews * Ensure outputs align with ...

Eaton

Sr Manufacturing Engineer (Second Shift)

Arecibo, PR · On-site

$78K - $107K/yr

... utilization, capacity, space requirements, material flow, and work processes to maximize ... Create, review, and maintain Job Safety Analyses (JSAs), Standard Work Instructions (SWIs ...

CERES

PR · On-site

$33 - $38/hr

Monitor productivity, quality, staffing levels, equipment utilization, and operational performance ... Review and approve employee time records, production reports, daily logs, and operational ...

Inkit

Senior Software Engineer

San Juan, PR · On-site

$120K - $158K/yr

  • Medical

  • Dental

  • Vision

  • PTO

Optimize application performance and resource utilization throughout the technology stack ... Provide mentorship and code reviews to help junior developers grow their skills * Champion software ...

Veterans Health Administration

$89K - $116K/yr

... review of the EDRP application. Former EDRP participants ineligible to apply Learn more about this ... Observes the utilization of recreation therapy treatment modalities to ensure the most beneficial ...

Veterans Health Administration

$89K - $116K/yr

  • PTO

... review of the EDRP application. Former EDRP participants ineligible to apply Learn more about this ... Observes the utilization of recreation therapy treatment modalities to ensure the most beneficial ...

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Utilization Review information

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 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.

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, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

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 August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution.

Program Manager

US Department of the Treasury

Mayaguez, PR • On-site

$125K/yr

Full-time

Posted 13 days ago

U.S. Department Of The Treasury rating

8.2

Company rating: 8.2 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

309th of 846 rated public administrative organizations

Job description

WHAT IS THE LARGE BUSINESS & INTERNATIONAL DIVISION? A description of the business units can be found at: https://www.jobs.irs.gov/about/who/business-divisions
  • Position(s) are to be filled in following area(s):
    • LBI - Strategic Programs

REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILSQualifications:

Federal experience is not required. Experience may have been gained in the public sector, private sector or through Volunteer Service. One year of experience refers to full-time work; part-timework is considered on a prorated basis. To ensure full credit for your work experience, please indicate dates of employment by month/day/year, and indicate number of hours worked per week, on your resume.
SPECIALIZED EXPERIENCE IR-1: To be minimally qualified for this position you must have at least one (1) year of specialized experience equivalent to the next lower-level payband or GS grade in the normal line of progression.
Specialized experience would include one year of substantive supervisory or program management experience at the GS-13 or GS-14 level or equivalent level manager or comparable management or leadership experiences outside of Federal service.
To be qualifying for this position your experience should be sufficient to demonstrate:

  • Experience leading strategic planning initiatives by evaluating legislative proposals, organizational priorities, policy changes, and emerging program issues; developing implementation strategies and long-range plans that support organizational objectives and mission requirements.
  • Experience analyzing program operations, organizational performance, workload data, resource utilization, operational risks, and program outcomes; identifying issues and developing recommendations that improve operational effectiveness, efficiency, and program performance.
  • Experience developing performance measures, evaluation criteria, and accountability processes used to monitor program accomplishments, assess organizational performance, evaluate results, and recommend operational improvements.
  • Experience preparing executive reports, briefing materials, written documentation, analytical studies, and recommendations that communicate complex findings, support organizational planning, and facilitate management decision-making.
  • Experience planning, coordinating, monitoring, and evaluating multiple projects or organizational initiatives involving competing priorities, changing requirements, resource constraints, and cross-functional stakeholders to achieve strategic program objectives.
  • Experience conducting operational research by evaluating program data, identifying organizational trends, assessing the impact of proposed changes, and developing evidence-based recommendations that improve program operations, policy implementation, or organizational performance.
  • Experience interpreting Federal tax laws, regulations, Internal Revenue Service program requirements, compliance guidance, and related policies to evaluate program impacts, resolve technical issues, develop recommendations, and support implementation of organizational initiatives.
  • Experience evaluating financial information, budget data, staffing requirements, workload trends, and resource utilization to develop recommendations that support strategic planning, operational priorities, and effective allocation of organizational resources.

AND

You must also meet the following requirement(s):
  • TIME AFTER COMPETITIVE APPOINTMENT (TACA): By the closing date (or if this is an open continuous announcement, by the cut-off date) specified in this job announcement, current civilian employees must have completed at least 90 days of federal civilian service since their latest non-temporary appointment from a competitive referral certificate, known as time after competitive appointment. For this requirement, a competitive appointment is one where you applied to and were appointed from an announcement open to "All US Citizens".

For more information on qualifications please refer to OPM's Qualifications Standards.
Go to Understanding the IRS Paybands for GS/IR conversion.

Education:A college or university degree generally must be from an accredited (or pre-accredited) college or university recognized by the U.S. Department of Education. For a list of schools which meet these criteria, please refer to Department of Education Accreditation page.
FOREIGN EDUCATION: Education completed in foreign colleges or universities may be used to meet the requirements. You must show proof the education credentials have been deemed to be at least equivalent to that gained in conventional U.S. education program. It is your responsibility to provide such evidence when applying. Click here (Section 3, Explanation of Terms) or here for Foreign Education Credentialing instructions.
We recommend choosing an evaluator from a member organization of one of the following national associations of credential evaluation services: National Association of Credential Evaluation Services (NACES) or Association of International Credentials Evaluators (AICE).Employment Type: OTHER

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