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Utilization Review Jobs in Westerly, RI (NOW HIRING)

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Managed Care Coordinator I

Carolina, RI · Remote

$19.25 - $26/hr

Work experience in healthcare program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation ...

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Utilization Review information

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$21

$42

$69

How much do utilization review jobs pay per hour?

As of Aug 5, 2026, the average hourly pay for utilization review in Westerly, RI is $42.59, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $48.89 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 popular job titles related to Utilization Review jobs in Westerly, RI? For Utilization Review jobs in Westerly, RI, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Westerly, RI look for? The top searched job categories for Utilization Review jobs in Westerly, RI are:
What cities near Westerly, RI are hiring for Utilization Review jobs? Cities near Westerly, RI with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Westerly, RI as of July 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, 1% Temporary, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $88,591 per year, or $42.6 per hour.

UTILIZATION REVIEW (UR) SPECIALIST - FULL OR PART TIME

UHS

North Stonington, CT • On-site

Full-time

Medical, Dental, Retirement

Re-posted 6 days ago

Universal Health Services rating

6.8

Company rating: 6.8 out of 10

Based on 253 frontline employees who took The Breakroom Quiz

491st of 887 rated healthcare providers

Job description

Responsibilities
Are you caring, compassionate and hardworking? Our facility can provide a place for you to thrive and continue your professional development.
Stonington Institute, a division of one of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS), has an immediate opening for a full or part time UR Specialist.
Stonington Institute is committed to providing quality substance abuse treatment options for adults in Southeastern Connecticut and surrounding areas. We offer medical detox as well as residential addictions treatment for active duty and retired military service members in our North Stonington location. Our clinic in Groton, CT, offers partial hospitalization and intensive outpatient treatment, and is conveniently located across the street from The Inn at Trails Corner, a new 180 bed dormitory-style sober community for adult men and women who attend our outpatient day treatment programs. The Inn offers overnight accommodations, full-meal service, indoor/outdoor recreation options, a workout room, and computer center for all clients. We accept private insurance, state-funded plans and self-pay arrangements.
Job Summary:
The Utilization Review Specialist is responsible for the pre-certification, concurrent, and discharge review process for clients at all levels of care, resulting in the approval of their admission and continued treatment.
Job Duties and Responsibilities
  • Consult with Admissions Department regarding specific LOC issues, insurance requests, and/or criteria questions.
  • Complete initial precertification for all levels of care.
  • Knowledge of UR processes required for all payor sources i.e. precertification, concurrent reviews, discharge review.
  • Conduct concurrent reviews on assigned cases.
  • Ability to identify and advocate for a particular level of care based on the presenting clinical information.
  • Coordinate with colleagues and payors regarding client changes in level of care internally or transitions to other internal programs.
  • Collaborate with clinicians/case managers to obtain pertinent clinical and discharge information.
  • Learn UR Tracking System, Midas; enter daily authorizations and/or other necessary information in a timely manner.
  • Print and monitor UR reports on a daily basis.
  • Document and file all authorization information accurately and completely.
  • Address client insurance changes immediately and communicate results to appropriate departments.
  • Ensure that all applicable information is communicated to the Billing Department on a daily basis.
  • Notify UR Department Head and Billing of any denials and complete telephonic or written appeals when necessary.
  • Liaison between insurance and clinical staff, providing information to clinicians/case managers regarding dispositions that would be approved by insurance.
  • Participate in monthly UR Meeting.

Stonington Institute employees receive great opportunities.
  • Challenging and rewarding work environment
  • Career advancement opportunities
  • Comprehensive Benefits including Medical, Dental, 401K, Tuition Reimbursement and more (for eligible part-time and full-time positions)
  • Competitive Compensation.
Apply today to join our amazing team!
About Universal Health Services
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.
We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.
Qualifications
Masters Degree preferred; minimum Bachelors Degree in Psychology or related Human Service Field or RN. Knowledge of Utilization Review Processes, insurance plans, mental health and chemical dependency treatment. Knowledge of various treatment levels of care as well as psychiatric diagnosis. Experience with computer skills preferred.

What Universal Health Services employees say

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About Universal Health Services

Sourced by ZipRecruiter

Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

King of Prussia, PA, US

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