The Director of Utilization Review (UR) is to manage effectively and efficiently all aspects of the MDS/ Case management / Restorative/ Care planning/ 5 Star and Quality Measures while capturing ...
New
Quick apply
The Director of Utilization Review (UR) is to manage effectively and efficiently all aspects of the MDS/ Case management / Restorative/ Care planning/ 5 Star and Quality Measures while capturing ...
New
Utilization Management Rep I
Seven Fields, PA · On-site
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Seven Fields, PA · On-site
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Seven Fields, PA · On-site
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Seven Fields, PA · On-site
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Seven Fields, PA · On-site
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Seven Fields, PA · On-site
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Seven Fields, PA · On-site
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Seven Fields, PA · On-site
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Mars, PA · On-site
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Mars, PA · On-site
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Preferred: Perioperative and managed care, Case Management, and/or Utilization Review experience. Other Requirements: Excellent communication skills and skills in customer service. Physical ...
Preferred: Perioperative and managed care, Case Management, and/or Utilization Review experience. Other Requirements: Excellent communication skills and skills in customer service. Physical ...
... utilization review principles and criteria, insurance benefits and limitations, transition planning requirements, length of stay, and resource utilization. (10%) * Actively seeks professional ...
... utilization review principles and criteria, insurance benefits and limitations, transition planning requirements, length of stay, and resource utilization. (10%) * Actively seeks professional ...
... utilization review principles and criteria, insurance benefits and limitations, transition planning requirements, length of stay, and resource utilization. (10%) * Actively seeks professional ...
... utilization review principles and criteria, insurance benefits and limitations, transition planning requirements, length of stay, and resource utilization. (10%) * Actively seeks professional ...
... utilization review principles and criteria, insurance benefits and limitations, transition planning requirements, length of stay, and resource utilization. (10%) * Actively seeks professional ...
... utilization review principles and criteria, insurance benefits and limitations, transition planning requirements, length of stay, and resource utilization. (10%) * Actively seeks professional ...
Team Leader-CRR Butler
Butler, PA · On-site
$16.25 - $21.75/hr
Conducts ongoing utilization review activities including adherence to managed care standards. * Other duties as required. * Adheres to all policies, laws, regulations and codes of ethics and ...
Team Leader-CRR Butler
Butler, PA · On-site
$16.25 - $21.75/hr
Conducts ongoing utilization review activities including adherence to managed care standards. * Other duties as required. * Adheres to all policies, laws, regulations and codes of ethics and ...
Team Leader-CRR Butler
Butler, PA · On-site
$16.25 - $21.75/hr
Conducts ongoing utilization review activities including adherence to managed care standards. * Other duties as required. * Adheres to all policies, laws, regulations and codes of ethics and ...
Team Leader-CRR Butler
Butler, PA · On-site
$16.25 - $21.75/hr
Conducts ongoing utilization review activities including adherence to managed care standards. * Other duties as required. * Adheres to all policies, laws, regulations and codes of ethics and ...
Pharmacy Intern
Aliquippa, PA · On-site
$15.75 - $19.50/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Aliquippa, PA · On-site
$15.75 - $19.50/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
$15.75 - $19.75/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
$15.75 - $19.75/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Ellwood City, PA · On-site
$16 - $20/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Ellwood City, PA · On-site
$16 - $20/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Aliquippa, PA · On-site
$15.75 - $19.50/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Aliquippa, PA · On-site
$15.75 - $19.50/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Wexford, PA · On-site
$15.75 - $19.75/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Wexford, PA · On-site
$15.75 - $19.75/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Gibsonia, PA · On-site
$15.25 - $19/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Gibsonia, PA · On-site
$15.25 - $19/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Ellwood City, PA · On-site
$16 - $20/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Pharmacy Intern
Ellwood City, PA · On-site
$16 - $20/hr
Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...
Grad Pharmacist
Monaca, PA · On-site
$15.25 - $19/hr
... drug utilization review (DUR), pharmacy professional standards such as corresponding responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that ...
Grad Pharmacist
Monaca, PA · On-site
$15.25 - $19/hr
... drug utilization review (DUR), pharmacy professional standards such as corresponding responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that ...
Utilization Review information
See Butler, PA salary details
$19.29 - $23.19
2% of jobs
$23.19 - $27.09
9% of jobs
$29.76 is the 25th percentile. Wages below this are outliers.
$27.09 - $30.99
21% of jobs
The median wage is $34.15 / hr.
$30.99 - $34.89
23% of jobs
$34.89 - $38.79
13% of jobs
$41.83 is the 75th percentile. Wages above this are outliers.
$38.79 - $42.69
10% of jobs
$42.69 - $46.59
8% of jobs
$46.59 - $50.49
5% of jobs
$50.49 - $54.39
5% of jobs
$54.39 - $58.30
2% of jobs
$58.30 - $62.20
2% of jobs
$19
$38
$62
How much do utilization review jobs pay per hour?
As of Aug 29, 2026, the average hourly pay for utilization review in Butler, PA is $38.12, according to ZipRecruiter salary data. Most workers in this role earn between $30.14 and $43.80 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 popular job titles related to Utilization Review jobs in Butler, PA?
For Utilization Review jobs in Butler, PA, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Butler, PA look for?
The top searched job categories for Utilization Review jobs in Butler, PA are:
What cities near Butler, PA are hiring for Utilization Review jobs?
Cities near Butler, PA with the most Utilization Review job openings:
Director of Utilization Review
Beaver, PA
Brighton Rehabilitation & Wellness Center
Full-time
Posted 2 days ago
New
Job description
The Director of Utilization Review (UR) is to manage effectively and efficiently all aspects of the MDS/ Case management / Restorative/ Care planning/ 5 Star and Quality Measures while capturing clinical reimbursement. This should be done while following the RAI manual, DOH guidelines, CMS guidelines, Federal and State Guidelines and Corporate Compliance.
1) Graduate of an accredited School of Nursing with current Pennsylvania nursing license
2) Maintain CEU credits through seminars, in-service programs, and professional journals relative to professional growth
3) Strong knowledge of the RAI, MDS, state and federal guidelines, 5 star reporting and quality measures, and restorative nursing