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Utilization Review Jobs in Covington, KY (NOW HIRING)

Elevance Health

Utilization Management Rep I

Mason, OH · 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 ...

Elevance Health

Utilization Management Rep I

Mason, OH · 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 ...

New Vista Behavioral Health

UM Coordinator

Cincinnati, OH · On-site

$18 - $24/hr

Position Summary The Utilization Management (UM) Coordinator supports the facility's utilization review and authorization processes for patients receiving mental health and behavioral health services.

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Utilization Review information

See Covington, KY salary details

$20

$41

$66

How much do utilization review jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for utilization review in Covington, KY is $41.04, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $47.12 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 Covington, KY?

For Utilization Review jobs in Covington, KY, the most frequently searched job titles are:

What cities near Covington, KY are hiring for Utilization Review jobs?

Cities near Covington, KY with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Covington, KY as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $85,364 per year, or $41 per hour.

Utilization Review RN

Healthcare Support Staffing

Mason, OH • On-site

Full-time

Medical, Dental, Vision

Re-posted yesterday

Job description

Company Description

Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

This is a utilization review position. Nurses will be responsible for collaborating with healthcare providers and members to promote quality member outcomes to optimize member benefits and to promote effective use of resources.

Essentially they will be reviewing patient records and treatment profiles to ensure proper and cost effective treatment, member satisfaction, and quality results. They will be doing both inpatient and outpatient UM.


Qualifications

Job Description:

This is a utilization review position. Nurses will be responsible for collaborating with healthcare providers and members to promote quality member outcomes to optimize member benefits and to promote effective use of resources.

Essentially they will be reviewing patient records and treatment profiles to ensure proper and cost effective treatment, member satisfaction, and quality results. They will be doing both inpatient and outpatient UM.


Additional Information

Hours for this Position: M-F: 8am-4:30pm


Advantages of this Opportunity: 

Competitive salary, negotiable based on relevant experience

Benefits offered, Medical, Dental, and Vision

Fun and positive work environment


Additional Information: 6-12 month long term contract

Interested in being considered? 

If you are interested in applying to this position, please click the Green I'm Interested Button to email your resume. 


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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