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Utilization Review Jobs (NOW HIRING)

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care services. Through regular utilization reviews and audits, the UR nurse ensures that patients ...

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care services. Through regular utilization reviews and audits, the UR nurse ensures that patients ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing an intentionally different approach to mental health and well-being. We are a combination of bricks ...

Oscar Health

Utilization Review Nurse

Manhattan, NY · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About The Role You will perform frequent case reviews, check medical records and speak with care providers regarding ...

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How much do utilization review jobs pay per hour?

As of Jun 3, 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 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.

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.
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Utilization Review jobs near you
Infographic showing various Utilization Review job openings in the United States as of May 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Nurse Utilization Review

Nurse Utilization Review

Midland Health

Midland, TX • On-site

Full-time

Medical

Posted 18 days ago

Job description

Job Description
The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care services. Through regular utilization reviews and audits, the UR nurse ensures that patients receive the care they need without unnecessary diagnostic procedures, ineffective treatments or extended hospital stays. The utilization review examines how health care services are being utilized. The UR nurse requires extensive knowledge of patient care, medical treatments and hospital procedures. The UR nurse will rely on their clinical judgment, honed over years in acute care settings, to make responsible decisions that promote patient health and well-being while keeping resources available to those most in need. The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping patients make informed decisions about their health care by educating them on the benefits and limitations of their Medicare, Medicaid or private health care coverage.
SHIFT AND SCHEDULE
Full Time, Monday - Friday; 8:00 AM - 5:00 PM
ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS
• Able to utilize electronic healthcare record (EHR) and billing systems, filter and prioritize UM Worklist, document Utilization Management (UM) reviews of various types, enter notes, locate insurance information, provide clinical updates to 3rd Party payors, place accounts on hold and release, and manage concurrent denials.
• Proficiently navigate within the EHR and the UM platform to gather documented information concerning the patient to establish appropriate utilization of hospital services.
• Conducts and documents an UM Review at time of admission or the next working day.
• Conducts and documents concurrent UM reviews no more than 3 days after admission review has been completed. Refers to Physican Advisor appropriately.
• Performs an in-depth Extended Stay review on patients with a stay greater than 5 days and refers to Physician Advisor appropriately.
• Utilizes and applies UM platform Care Level Scores along with clinical expertise, to validate medical necessity of the ordered admission status, appropriateness of treatment, and ordered level of care.
• Confers with attending physician or Physician Advisor when appropriate to make a determination about medical necessity.
• Communicates and works closely with insurance companies to ensure that the organization will be reimbursed for services rendered. Providing supporting documentation to justify medical necessity of the admission or continuation of stay.
• Assists and educates Medical Staff and other members of the healthcare team with regards to utilization issues such as, but not limited to:
Admission Status
Level of Care
Medical Necessity
Costs and best practices of treatment
Expected Length of Stay (LOS)
• Functions as a resource to the healthcare team regarding approved criteria, practice guidelines, and alternative treatment options.
• Provides monthly reporting to the Utilization Management/Case Management Committee regarding inappropriate admissions.
• Assists with ensuring compliance with CMS Conditions of Participation for Utilization Review, Appendix A/§42 CFR 482.30
EDUCATION AND EXPERIENCE
Current State of Texas License as a Registered Nurse.
5 years of nursing experience (preferably in utilization management or hospital/acute care).
Computer proficiency in Microsoft Office
PHYSICAL REQUIREMENTS
• To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to: Ø Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.

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