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Utilization Review Jobs in Jackson, MS (NOW HIRING)

UHS

UR COORDINATOR

Flowood, MS · On-site

Responsibilities We are looking for looking for a dynamic Utilization Review Coordinator to join our team! Monday - Friday 8A - 4:30P Brentwood Behavioral Healthcare is a provider of quality ...

UHS

UR COORDINATOR

Flowood, MS · On-site

Responsibilities We are looking for looking for a dynamic Utilization Review Coordinator to join our team! Monday - Friday 8A - 4:30P Brentwood Behavioral Healthcare is a provider of quality ...

Humana

Compliance UM Nurse (Wed - Sun)

Jackson, MS · On-site

Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...

FMOLHS

Experienced Case Manager - RN

Jackson, MS · On-site

The Case Manager directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific ...

GQR

RN - Case Manager

Jackson, MS · On-site

$2.2K - $2.3K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Jackson, Mississippi Start Date: August 6, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $2241 ...

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All JobsUtilization Review JobsUtilization Review Jobs in Jackson, MS

Utilization Review information

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$18

$36

$60

How much do utilization review jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for utilization review in Jackson, MS is $36.85, according to ZipRecruiter salary data. Most workers in this role earn between $29.13 and $42.31 per hour, depending on experience, location, and employer.

Is utilization review work from home?

Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.

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.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.

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 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, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.
What are the most commonly searched types of Utilization Review jobs in Jackson, MS? The most popular types of Utilization Review jobs in Jackson, MS are:
What are popular job titles related to Utilization Review jobs in Jackson, MS? For Utilization Review jobs in Jackson, MS, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Jackson, MS look for? The top searched job categories for Utilization Review jobs in Jackson, MS are:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Jackson, MS as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $76,639 per year, or $36.8 per hour.

RN - Utilization Review - Utilization Review

University of Mississippi Medical Center

Jackson, MS • On-site

Other

This job post has expired 3 days ago. Applications are no longer accepted.

University Of Mississippi Medical Center rating

7.4

Company rating: 7.4 out of 10

Based on 47 frontline employees who took The Breakroom Quiz

347th of 1,059 rated hospitals

Job description

Hello,
Thank you for your interest in career opportunities with the University of Mississippi Medical Center. Please review the following instructions prior to submitting your job application:

  • Provide all of your employment history, education, and licenses/certifications/registrations. You will be unable to modify your application after you have submitted it.
  • You must meet all of the job requirements at the time of submitting the application.
  • You can only apply one time to a job requisition.
  • Once you start the application process you cannot save your work. Please ensure you have all required attachment(s) available to complete your application before you begin the process.
  • Applications must be submitted prior to the close of the recruitment. Once recruitment has closed, applications will no longer be accepted.
After you apply, we will review your qualifications and contact you if your application is among the most highly qualified. Due to the large volume of applications, we are unable to individually respond to all applicants. You may check the status of your application via your Candidate Profile.
Thank you,
Human Resources
Important Applications Instructions:
Please complete this application in entirety by providing all of your work experience, education and certifications/
license. You will be unable to edit/add/change your application once it is submitted.
Job Requisition ID:
R00050784
Job Category:
Nursing
Organization:
Utilization Review
Location/s:
Main Campus Jackson
Job Title:
RN - Utilization Review - Utilization Review
Job Summary:
RN-Utilization Review is accountable to perform utilization management services for designated patient case load, including prospective, concurrent, retrospective, and denial management reviews by applying clinical protocols and review medical necessity criteria. Reports quality of care issues identified during the utilization management process to the appropriate manager.
Education & Experience
Education and Experience Required:
One (1) year of nursing experience in an inpatient setting.
Certifications, Licenses, or Registration required:
Valid RN license.
Knowledge, Skills & Abilities
Knowledge, Skills, and Abilities:
Knowledge of utilization review, discharge planning, case management, and managed care reimbursement. Strong working knowledge of medical procedures, diagnoses, and procedure codes, including ICD-10, CPT, and DSM-IV. Excellent interpersonal, verbal, written communication, and negotiation skills. Ability to gather data, prepare reports, and identify process improvements. Able to work independently, exercise sound judgment, and apply medical necessity guidelines with minimal supervision. Committed to quality patient care, customer service, safety, cost efficiency, and continuous quality improvement (CQI). Proficient in the use of computers and related software applications.
Responsibilities:
  • Performs prospective, concurrent, retrospective, and denials review for individual cases, including benefit coverage, medical necessity, appropriate level of care, and mandated services.
  • Assists in collecting and reporting financial and performance indicators, including case mix, length of stay, cost per case, resource utilization, readmission rates, denials, and appeals.
  • Uses data to drive decisions and implement performance improvement strategies related to case management, including fiscal, clinical, and patient satisfaction outcomes.
  • Collects and analyzes variances from the plan of care and collaborates with physicians and the healthcare team to address issues and improve outcomes.
  • Applies clinical appropriateness criteria to monitor admissions and continued stays, identifies at-risk populations, and refers cases to the care management physician advisor as needed.
  • Communicates with third-party payers to facilitate reimbursement certification, resolves payor issues, and completes utilization management and quality screening for assigned patients.
  • Works collaboratively with the interdisciplinary care team to ensure timely, appropriate patient management, remove barriers to care, and proactively address delays or discharge obstacles.
  • Ensures safe, high-quality care in compliance with policies, procedures, and standards, while managing time, supplies, productivity, and accuracy within budgetary guidelines.
  • The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands:
Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, no handling or working with potentially dangerous equipment, occasional working hours beyond regularly scheduled hours, occasional travelling to offsite locations, occasional activities subject to significant volume changes of a seasonal/clinical nature, occasional work produced is subject to precise measures of quantity and quality, occasional bending, occasional lifting/carrying up to 10 pounds, occasional lifting/carrying up to 25 pounds, no lifting/carrying up to 50 pounds, no lifting/carrying up to 75 pounds, no lifting/carrying up to100 pounds, no lifting/carrying 100 pounds or more, no climbing, no crawling, occasional crouching/stooping, no driving, occasional kneeling, occasional pushing/pulling, occasional reaching, frequent sitting, occasional standing ,occasional twisting, and frequent walking. (Occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)
Time Type:
Full time
FLSA Designation/Job Exempt:
Yes
Pay Class:
Salary
FTE %:
100
Work Shift:
Day
Benefits Eligibility:
Grant Funded:
No
Job Posting Date:
07/7/2026
Job Closing Date (open until filled if no date specified):

What University Of Mississippi Medical Center employees say

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About University of Mississippi Medical Center

Sourced by ZipRecruiter

The University of Mississippi Medical Center (UMMC) is the state's sole academic medical center, focused on enhancing the lives of Mississippi residents through education, research, and healthcare. UMMC houses seven health science schools with over 3,000 enrolled students, and its researchers are renowned for their contributions to areas like heart disease, diabetes, hypertension, and cancer treatment. Their efforts not only improve health outcomes but also drive economic growth and job opportunities in the state.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Jackson, MS, US

Year founded

1955

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