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Utilization Review Jobs in Philadelphia, PA (NOW HIRING)

Penn Medicine

Utilization Review Nurse

West Chester, PA · On-site

The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and ...

IntePros

Utilization Review Nurse

Philadelphia, PA · On-site

This role is responsible for performing utilization management reviews to determine the medical necessity of requested healthcare services, ensuring members receive appropriate, evidence-based care ...

Genex Services

Utilization Reviewer 2

Wayne, PA · On-site

$52K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in ...

Enlyte

Utilization Reviewer 2

Wayne, PA · On-site

$52K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in ...

Enlyte

Utilization Reviewer 2

Wayne, PA

$52K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in ...

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All JobsUtilization Review JobsUtilization Review Jobs in Philadelphia, PA

Utilization Review information

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How much do utilization review jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for utilization review in Philadelphia, PA is $42.67, according to ZipRecruiter salary data. Most workers in this role earn between $33.70 and $48.99 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 Philadelphia, PA?

The most popular types of Utilization Review jobs in Philadelphia, PA are:

What are popular job titles related to Utilization Review jobs in Philadelphia, PA?

For Utilization Review jobs in Philadelphia, PA, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Philadelphia, PA look for?

The top searched job categories for Utilization Review jobs in Philadelphia, PA are:

What cities near Philadelphia, PA are hiring for Utilization Review jobs?

Cities near Philadelphia, PA with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Philadelphia, PA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $84,053 per year, or $40.4 per hour.

Utilization Review Specialist

Chadds Ford, PA • On-site

Diversified Treatment Alternative Centers
Offices of Mental Health Practitioners • 51 - 200 employees
Learn more about Diversified Treatment Alternative Centersexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Utilization Review (UR) Specialist
Location: Chadds Ford, Pennsylvania (Hybrid / Remote Eligible)
Job Type: Full-Time
Schedule: Monday - Friday
Overview
Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented and experienced Utilization Review (UR) Specialist to support our behavioral health programs.
This role plays a critical part in ensuring services are medically necessary, appropriately authorized, and compliant with payer, state, and regulatory requirements while supporting timely reimbursement and quality care delivery.
Why Join DTAC
  • Flexible hybrid or remote work options
  • Collaborative, cross-functional team environment
  • Meaningful work supporting behavioral health services
  • Stable organization focused on quality and growth
  • Opportunities for professional development

Position Summary
The Utilization Review Specialist manages the full lifecycle of authorizations and eligibility verification. This role collaborates closely with Clinical, Admissions, and Revenue Cycle teams to ensure compliance, minimize denials, and support accurate billing and reimbursement.
Key Responsibilities
  • Conduct initial, concurrent, and continued stay utilization reviews
  • Submit, track, and manage authorizations and reauthorizations
  • Communicate authorization updates with clinical and admissions teams
  • Maintain accurate documentation in EHR and billing systems
  • Perform ongoing eligibility verification for active clients
  • Identify coverage changes and communicate impacts to appropriate teams
  • Review clinical documentation for medical necessity and compliance
  • Collaborate with clinicians to address documentation gaps
  • Support denial prevention and revenue cycle optimization
  • Assist with appeals and utilization-related inquiries
  • Participate in audits, quality improvement initiatives, and compliance reviews
  • Stay current with payer requirements and regulatory updates

Qualifications
Required:
  • Bachelor's degree in Healthcare Administration, Nursing, Social Work, Psychology, or related field
  • Minimum of 1-3 years of experience in utilization review, case management, or behavioral health revenue cycle
  • Strong understanding of medical necessity and authorization processes
  • Excellent attention to detail and analytical skills
  • Strong written and verbal communication skills

Preferred:
  • Experience with Pennsylvania and Ohio behavioral health payers
  • Familiarity with EHR systems and billing workflows
  • Experience supporting audits, compliance reviews, or appeals

Requirements
  • Ability to manage multiple priorities and deadlines
  • Strong collaboration across clinical, billing, and administrative teams
  • Commitment to compliance with regulatory and payer requirements
  • Ability to work hybrid or remotely depending on organizational needs

Benefits
  • 401(k)
  • Health, Dental, and Vision Insurance
  • Health Savings Account
  • Paid Time Off
  • Life and Disability Insurance
  • Employee Assistance Program
  • Referral Program

Work Location
This position is based in Chadds Ford, PA (19317) with hybrid or remote work options available based on business needs.
Apply Today
If you are a detail-driven professional with experience in utilization review or behavioral health operations, we encourage you to apply and join DTAC's team.
Equal Opportunity Employer
Diversified Treatment Alternative Centers is committed to providing equal employment opportunities and maintaining an inclusive workplace in accordance with all applicable laws.

Apply