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Utilization Review Jobs in Spring Hill, TN (NOW HIRING)

Vertek Staffing

CDI Specialist

Franklin, TN · Remote

$33.50 - $45/hr

The CDI Specialist will work collaboratively with HIM, Coding, Case Management, Utilization Review, Physician Advisors, and providers to support accurate and complete clinical documentation. Key ...

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Showing results 21-40

All JobsUtilization Review JobsUtilization Review Jobs in Spring Hill, TN

Utilization Review information

See Spring Hill, TN salary details

$20

$39

$64

How much do utilization review jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for utilization review in Spring Hill, TN is $39.76, according to ZipRecruiter salary data. Most workers in this role earn between $31.44 and $45.67 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 Spring Hill, TN?

The most popular types of Utilization Review jobs in Spring Hill, TN are:

What are popular job titles related to Utilization Review jobs in Spring Hill, TN?

For Utilization Review jobs in Spring Hill, TN, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Spring Hill, TN look for?

The top searched job categories for Utilization Review jobs in Spring Hill, TN are:

What cities near Spring Hill, TN are hiring for Utilization Review jobs?

Cities near Spring Hill, TN with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Spring Hill, TN as of August 2026, with employment types broken down into 16% As Needed, 79% Full Time, and 5% Part Time. Highlights an 74% In-person, and 26% Remote job distribution, with an average salary of $82,696 per year, or $39.8 per hour.

Utilization Management Nurse

archwellhealth

Nashville, TN • On-site

Full-time

Re-posted 11 days ago

Job description

Job Summary:

Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating medical services, treatments, and procedures. This role identifies trends for opportunities to educate and collaborate with healthcare providers, patients, and specialists to optimize resource utilization and improve patient outcomes.

Duties/Responsibilities:

 

  • Conducts prospective, concurrent, and retrospective utilization reviews for medical necessity to ensure treatment and services are appropriate and necessary by reviewing medical records and treatment plans.
  • Works collaboratively with healthcare providers and Medical Directors to provide guidance on approvals or requests for health plan determination reviews as applicable utilizing CMS clinical guidelines and insurance policies.
  • Maintains accurate and detailed records of reviews, interventions, and communications to ensure adherence to health plan requirements and organizational policies.
  • Analyze utilization trends to ensure progress towards organizational goals
  • Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
  • Collaborates with Network and specialists to identify opportunities to educate on value-based care, resolve specialty gaps by markets, improve cost-effectiveness and coordination of care to meet patient needs.

Required Skills/Abilities:

  • Strong knowledge of utilization management functions in value-based care, including data analysis, claims review, reimbursement practices, and medical records reviews.
  • Thorough, in-depth knowledge of evidence-based practice, legal rules and regulations and best practices in healthcare
  • Ability to effectively leverage business and organizational knowledge within and across functional areas
  • Must possess a high degree of emotional intelligence and integrity, driven and focused work ethic
  • Continuous desire to learn and embrace new methods; ability to adapt and be resilient.
  • Self-starter with the ability to think creatively and work effectively
  • Ability to build a relationship and work effectively with various seniorities and diverse populations.
  • Excellent critical reasoning, decision-making, and problem-solving skills to make informed decisions and ensure effective resource utilization while maintaining quality patient care.
  • Willingness and ability to travel, up to 20%

Education and Experience:

 

  • AA/AS degree in Nursing required; BA/BS degree in Nursing (BSN) or Healthcare Administration preferred
  • A valid, active Registered Nurse (RN) license in state(s) of employment required
  • A minimum of 3 years’, current direct utilization management required 
  • Work in an acute care facility, community-based clinic, public health department or specialization with the senior population preferred
  • Proficient PC skills
  • Fluency in Spanish or other languages spoken by people in the communities we serve is desirable, but not required

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

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