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How much do utilization review jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for utilization review in Spokane, WA is $42.75, according to ZipRecruiter salary data. Most workers in this role earn between $33.80 and $49.09 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.
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Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Spokane, WA as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, and 4% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $88,924 per year, or $42.8 per hour.

Care Review Clinician II

Integrated Resources INC

Spokane, WA • On-site

Contractor

Re-posted 12 days ago

Job description

Company Description

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Title: Medical Claims Review Nurse

Duration: 3 months (Temp to Hire)

Location: Spokane, WA

Responsibilities:

Non-exempt employee, 40 hours per week. Hours of operation 6 am - 5 pm. The manager is open for the employee to pick their start time as long as they know they must complete and 8 hour shift. They can choose.

This not remote, in office.

Production Guidelines after training- manager does 100% review of case on the first 2 months, so they receive feedback and then after that, they are audited monthly on a percentage of their caseloads and given feedback on the audited cases.

Managers are looking for candidates with clinical experience from a hospital (Preferred)

Min. 2- 3 years clinical nursing experience

1 year of utilization review or medical claim review

RN License Required

Preferred Experience in one of more of the following areas critical care, emergency medicine, surgical, paediatrics, advanced practice nursing, and billing and coding experience

Great organizational skills

Critical thinkers and the ability to make decisions using clinical background/knowledge

Able to work independently

Able to collaborate and work with peers to make decisions

Knowledge of state and federal regulations

In-depth Knowledge of ICD-9, CPT, and HCPTS

Great Verbal and Written Communication Skills because they will be interacting with Medical Directors.

Interviews: Phone screen and if it goes well then an in person interview

Knowledge/Skills/Abilities:

Demonstrated ability to communicate, problem solve, and work effectively with people.

Excellent organizational skill with the ability to manage multiple priorities.

Work independently and handle multiple projects simultaneously.

Knowledge of applicable state, and federal regulations.

In depth knowledge of Interqual and other references for length of stay and medical necessity determinations.

Experience with NCQA.

Ability to take initiative and see tasks to completion.

Computer Literate (Microsoft Office Products).

Excellent verbal and written communication skills.

Ability to abide by policies.

Ability to maintain attendance to support required quality and quantity of work.

Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

Skilled at establishing and maintaining positive and effective work relationships with co-workers, clients, members, providers and customers.

Required Experience:

Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.

Required Licensure/Certification: Active, unrestricted State.

Additional Information

Kind Regards

Sumit Agarwal

732-902-2125

Integrated Resources logo

About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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