Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams
Utilization Management Medical Director - Medical Oncology - Remote anywhere in US
Houston, TX · Remote
$248K - $373K/yr
Perform utilization review determinations for oncology populations, and support case and disease management teams to achieve optimal clinical outcomes * Serve as a subject matter expert in evidence ...
Utilization Management Medical Director - Medical Oncology - Remote anywhere in US
Houston, TX · Remote
$248K - $373K/yr
Perform utilization review determinations for oncology populations, and support case and disease management teams to achieve optimal clinical outcomes * Serve as a subject matter expert in evidence ...
Utilization Management Medical Director - Medical Oncology - Remote anywhere in US
Houston, TX · On-site +1
$248K - $373K/yr
Perform utilization review determinations for oncology populations, and support case and disease management teams to achieve optimal clinical outcomes * Serve as a subject matter expert in evidence ...
Utilization Management Medical Director - Medical Oncology - Remote anywhere in US
Houston, TX · On-site +1
$248K - $373K/yr
Perform utilization review determinations for oncology populations, and support case and disease management teams to achieve optimal clinical outcomes * Serve as a subject matter expert in evidence ...
Manager of ED & Observation (OBS) Case Management
Houston, TX · On-site
$108K - $130K/yr
The Manager will collaborate with physicians, nursing teams, social workers, utilization review staff, and interdisciplinary healthcare professionals to support timely discharge planning, resource ...
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Manager of ED & Observation (OBS) Case Management
Houston, TX · On-site
$108K - $130K/yr
The Manager will collaborate with physicians, nursing teams, social workers, utilization review staff, and interdisciplinary healthcare professionals to support timely discharge planning, resource ...
Manager, Emergency Department (ED) and Observation Case Management
Houston, TX · On-site
$108K - $130K/yr
Key Responsibilities • Direct daily operations of case management services in the Emergency Department and Observation areas • Manage utilization review activities to ensure appropriate level-of ...
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Manager, Emergency Department (ED) and Observation Case Management
Houston, TX · On-site
$108K - $130K/yr
Key Responsibilities • Direct daily operations of case management services in the Emergency Department and Observation areas • Manage utilization review activities to ensure appropriate level-of ...
Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and ...
Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
MAJOR DUTIES AND RESPONSIBILITIES: • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short ...
Manager of ED & Observation (OBS) Case Management - Adult Medical Center
Houston, TX · On-site
$108K - $130K/yr
The Manager will partner with physicians, nursing leadership, social work, utilization review teams, and interdisciplinary healthcare professionals to improve patient outcomes, optimize discharge ...
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Manager of ED & Observation (OBS) Case Management - Adult Medical Center
Houston, TX · On-site
$108K - $130K/yr
The Manager will partner with physicians, nursing leadership, social work, utilization review teams, and interdisciplinary healthcare professionals to improve patient outcomes, optimize discharge ...
RN Case Manager
Shenandoah, TX · On-site
Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...
RN Case Manager
Shenandoah, TX · On-site
Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...
Support Case Management (CM), Utilization Management (UM), and Clinical Documentation Integrity (CDI) teams through secondary case reviews, troubleshooting, and physician education. * Act as a ...
Support Case Management (CM), Utilization Management (UM), and Clinical Documentation Integrity (CDI) teams through secondary case reviews, troubleshooting, and physician education. * Act as a ...
Care Coordinator RN
Houston, TX · On-site
This role serves as a key clinical resource within the Admissions Department, partnering closely with Clinical Liaisons, Utilization Review, Admissions, and operational leadership to ensure ...
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Care Coordinator RN
Houston, TX · On-site
This role serves as a key clinical resource within the Admissions Department, partnering closely with Clinical Liaisons, Utilization Review, Admissions, and operational leadership to ensure ...
RN Case Manager
Conroe, TX · On-site
Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...
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RN Case Manager
Conroe, TX · On-site
Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...
RN Case Manager
Conroe, TX · On-site
Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...
RN Case Manager
Conroe, TX · On-site
Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...
Senior Case Manager, Manager
Houston, TX · On-site
$112K - $130K/yr
... utilization review, discharge planning, and clinical quality initiatives within a leading acute care hospital system. The Manager is responsible for overseeing the systems, processes, and daily ...
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Senior Case Manager, Manager
Houston, TX · On-site
$112K - $130K/yr
... utilization review, discharge planning, and clinical quality initiatives within a leading acute care hospital system. The Manager is responsible for overseeing the systems, processes, and daily ...
Manager, ED & Observation Case Management
Houston, TX · On-site
$108K - $130K/yr
Strong understanding of payer requirements, utilization review, care coordination, and performance improvement Benefits Compensation & Benefits * Base Salary: $108,867 - $130,000 * Annual Management ...
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Manager, ED & Observation Case Management
Houston, TX · On-site
$108K - $130K/yr
Strong understanding of payer requirements, utilization review, care coordination, and performance improvement Benefits Compensation & Benefits * Base Salary: $108,867 - $130,000 * Annual Management ...
What You'll Be Doing • Provide leadership and oversight for the trauma case management team • Manage utilization review, discharge planning, and care coordination activities for trauma patients ...
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What You'll Be Doing • Provide leadership and oversight for the trauma case management team • Manage utilization review, discharge planning, and care coordination activities for trauma patients ...
Nurse Case Manager
Houston, TX · On-site
Essential Duties and Responsibilities Case Management & Utilization Review * Provide telephonic case management support to assigned skilled nursing facilities. * Maintain active and accurate case ...
Nurse Case Manager
Houston, TX · On-site
Essential Duties and Responsibilities Case Management & Utilization Review * Provide telephonic case management support to assigned skilled nursing facilities. * Maintain active and accurate case ...
As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market ...
As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market ...
Nurse Case Manager
Houston, TX · On-site
Essential Duties and Responsibilities Case Management & Utilization Review * Provide telephonic case management support to assigned skilled nursing facilities. * Maintain active and accurate case ...
Nurse Case Manager
Houston, TX · On-site
Essential Duties and Responsibilities Case Management & Utilization Review * Provide telephonic case management support to assigned skilled nursing facilities. * Maintain active and accurate case ...
Utilization Review information
See Spring, TX salary details
$19.04 - $22.89
2% of jobs
$22.89 - $26.74
9% of jobs
$29.37 is the 25th percentile. Wages below this are outliers.
$26.74 - $30.59
21% of jobs
The median wage is $33.71 / hr.
$30.59 - $34.44
23% of jobs
$34.44 - $38.29
13% of jobs
$41.29 is the 75th percentile. Wages above this are outliers.
$38.29 - $42.14
10% of jobs
$42.14 - $45.99
8% of jobs
$45.99 - $49.84
5% of jobs
$49.84 - $53.69
5% of jobs
$53.69 - $57.54
2% of jobs
$57.54 - $61.39
2% of jobs
$19
$37
$61
How much do utilization review jobs pay per hour?
What jobs make $3,000 a day?
What jobs pay 4000 a week without a degree?
What does a typical day look like for someone working in Utilization Review?
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 skills do you need for utilization review?
What is a Utilization Review job?
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 the Utilization Review position, and why are they important?
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?

Contractor
Re-posted 16 days ago
Job description
- Independent Medical Examinations (IMEs)
- Peer Reviews
- Or both
Primary demand is within a 50-mile range of Houston, Texas, particularly in Orthopedic Surgery.
This is an independent contractor opportunity offering flexible, case-based assignments.
Responsibilities
- Conduct in-person, objective, defensible IMEs for Longshore cases
- Perform comprehensive peer reviews of medical records
- Provide detailed, timely written reports
- Maintain compliance with LHWCA standards and documentation requirements
Requirements
- Active, unrestricted Texas medical license
- US Board-certified or board-eligible in Orthopedic Surgery
- Must be AMA 6th Edition Certified (or willing to become certified)
- Prior Longshore IME and/or Peer Review experience strongly preferred but not required
- Strong analytical and report-writing skills
- Ability to manage case timelines independently
Preferred Experience
- Experience performing 30+ Longshore IMEs and/or Peer Reviews
- Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors
- Multi-state Longshore case experience
Benefits
- Opportunity for supplemental income
- Schedule flexibility and predictable work hours-conduct exams and reviews based on your schedule availability
- No doctor/patient relationship is established, and no treatment is provided. These are advisory-only opinions.
- Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise
- Expanded credentials as an expert in Independent Medical Exams
- Fully prepped cases, streamlined case flow, transcription services at no cost, and a user-friendly work portal
About Dane Street
Sourced by ZipRecruiter
Company size
51 - 200 Employees
Headquarters location
Boston, MA, US
Year founded
2008