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Utilization Review Jobs in West Virginia (NOW HIRING)

WVU Medicine

RN-ACT

Clarksburg, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care. Work is performed in accordance with ...

WVU Medicine

RN-ACT

Morgantown, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care. Work is performed in accordance with ...

WVU Medicine

RN-ACT

Morgantown, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care. Work is performed in accordance with ...

Dane Street

$20.75 - $28.50/hr

Requirements We are seeking an experienced CPC certified medical coder to perform coding audits, utilization reviews, audits and more. We are looking for someone who can provide litigation support ...

WVU Medicine

RN-ACT

Clarksburg, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care. Work is performed in accordance with ...

Dane Street

$20.75 - $28.50/hr

Requirements We are seeking an experienced CPC certified medical coder to perform coding audits, utilization reviews, audits and more. We are looking for someone who can provide litigation support ...

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All JobsUtilization Review JobsUtilization Review Jobs in West Virginia

Utilization Review information

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$16

$32

$53

How much do utilization review jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for utilization review in West Virginia is $32.73, according to ZipRecruiter salary data. Most workers in this role earn between $25.87 and $37.60 per hour, depending on experience, location, and employer.

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 West Virginia?

The most popular types of Utilization Review jobs in West Virginia are:

What are popular job titles related to Utilization Review jobs in West Virginia?

For Utilization Review jobs in West Virginia, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in West Virginia look for?

The top searched job categories for Utilization Review jobs in West Virginia are:

What cities in West Virginia are hiring for Utilization Review jobs?

Cities in West Virginia with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in West Virginia as of August 2026, with employment types broken down into 2% As Needed, 77% Full Time, 17% Part Time, 2% Contract, and 2% Nights. Highlights an 93% In-person, and 7% Remote job distribution, with an average salary of $68,085 per year, or $32.7 per hour.

RN - Utilization Review

Genesis - East Region - 5 Everett Tibbs Road Marlinton, WV

Marlinton, WV • On-site

Other

Posted 11 days ago

Job description

RN - Utilization Review

Excel is seeking highly skilled healthcare professionals for travel assignments across the United States. As a Travel Healthcare Professional, you will have the opportunity to work in diverse healthcare settings, providing essential medical care while exploring new locations and cultures.

Key Responsibilities:

  • Provide direct patient care in accordance with healthcare facility policies and procedures.
  • Collaborate with interdisciplinary teams to ensure comprehensive patient care.
  • Maintain accurate patient medical records and documentation.
  • Adhere to infection control standards and other regulatory requirements.
  • Educate patients and their families on healthcare plans and treatments.

Qualifications:

  • Active state licensure in [specify relevant states] (e.g., RN, LPN, PT, OT).
  • Minimum [number] years of experience in [specialty].
  • BLS/CPR certification (ACLS, PALS, or others as required by specialty).
  • Excellent communication and interpersonal skills.
  • Ability to adapt to different environments and work independently.

Why Choose Excel Medical Staffing:

  • Trusted partner with a proven track record in healthcare staffing.
  • Competitive compensation package including hourly wages and stipends.
  • Access to a wide range of healthcare facilities and specialties.
  • Personalized support throughout your assignment.
  • Opportunity to enhance your skills and build a diverse professional portfolio.

Client Details City Marlinton State WV

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