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Utilization Review Jobs (NOW HIRING)

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Prime Time Healthcare

Utilization Review

Washington, DC · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

Now Hiring: RN Utilization Review - Washington, DC Are you a passionate RN professional looking for a new adventure? Prime Time Healthcare is seeking dynamic individuals like you to join our team in ...

Washington Hospital

Utilization Review Liaison

Fremont, CA · On-site

$32.35 - $43.63/hr

Salary Range: $32.35 - $43.63 + applicable differentials Under the general supervision of the Director of Case Management, the Utilization Review (UR) Liaison is responsible for the assisting ...

Cobalt Benefits Group LLC

Director, Utilization Review

Exeter, NH · On-site

$135K - $155K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Director of Utilization Review is responsible for the strategic leadership, operational execution, and regulatory compliance of the Utilization Review (UR) program. This role ensures clinically ...

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Utilization Review information

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How much do utilization review jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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.
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Utilization Review jobs near you
Infographic showing various Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Acrisure

Bradenton, FL • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

Job description

About Acrisure
A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the right solutions to grow boldly forward. Bringing cutting-edge technology and top-tier human support together, we connect clients with customized solutions across a range of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more.
In the last twelve years, Acrisure has grown in revenue from $38 million to almost $5 billion and employs over 19,000 colleagues in more than 20 countries. Acrisure was built on entrepreneurial spirit. Prioritizing leadership, accountability, and collaboration, we equip our teams to work at the highest levels possible.
Job summary:
Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory requirements. This role reviews medical information submitted by treating providers, determines whether treatment can be authorized at the nurse level, and refers requests for physician review when additional clinical evaluation is required.
This position is ideal for an experienced LPN with a strong clinical background who enjoys applying their medical knowledge in an analytical, process-driven environment. Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly valued.
This is a hybrid position with two days per week in the office and three days remote. Candidates must also have flexibility to periodically work a later schedule to support business needs across multiple time zones.
Responsibilities:
  • Review medical treatment requests and supporting clinical documentation for adherence to applicable state guidelines and utilization review requirements
  • Apply clinical knowledge and established guidelines to determine whether treatment requests can be authorized at the nurse level
  • Refer treatment requests requiring additional clinical evaluation to physicians for review
  • Evaluate medical records and treatment information to support timely and appropriate utilization review decisions
  • Complete required documentation and administrative processing throughout the utilization review process
  • Manage assigned reviews within applicable state-mandated and URAC turnaround requirements
  • Accurately document treatment requests, clinical information, review activity, and determinations within client records
  • Maintain confidentiality of medical and client information in accordance with HIPAA and applicable standards
  • Collaborate with physicians, healthcare providers, claims professionals, and internal team members to facilitate the review process
  • Maintain current clinical and industry knowledge relevant to utilization review and workers' compensation
  • Provide responsive service while managing multiple reviews and competing deadlines

Requirements:
  • Active LPN license required
  • Active multistate/compact nursing license required
  • Strong clinical nursing experience with the ability to review medical records and evaluate treatment requests
  • Ability to interpret medical terminology, treatment plans, and clinical documentation
  • Ability to apply established clinical guidelines and determine when requests require physician review
  • Flexibility to periodically work later hours to support business needs across multiple time zones
  • Workers' compensation utilization review experience highly beneficial
  • Utilization review or case management experience highly beneficial
  • Clinical experience involving orthopedic or neurological conditions strongly preferred
  • Strong organizational skills with the ability to prioritize a high volume of time-sensitive reviews
  • Strong written and verbal communication skills
  • Proficiency with Microsoft Office applications and ability to learn new clinical and claims systems

Education and licenses:
  • Active Licensed Practical Nurse (LPN) license required
  • Active multistate/compact nursing license required
  • Additional utilization review, case management, workers' compensation, or related professional certifications beneficial

Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.
Why Join Us:
At Acrisure, we're building more than a business, we're building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.
Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York.
Employee Benefits
We also offer our employees a comprehensive suite of benefits and perks, including:
  • Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.
  • Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.
  • Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.
  • Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.
  • ... and so much more!

This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.
Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting leaves@acrisure.com.
Final candidates will be required to complete post-offer verification processes related to the role and in accordance with applicable laws.
California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.
Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice.
Welcome, your new opportunity awaits you.

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