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Utilization Review Jobs (NOW HIRING)

Village Care

Utilization Review Nurse

Manhattan, NY · Remote

$95K - $105K/yr

RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - NY, NJ, or CT COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is ...

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level) * Independent external reviews * DRG validation and clinical review * Benefit and coverage ...

PARKSIDE INC

Utilization Review Specialist

Tulsa, OK · On-site

The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private ...

Sheppard Pratt

Utilization Review Specialist

Towson, MD · On-site

$26.04/hr

Responsible for supporting the utilization review system including data analysis, report writing, and program improvement. * UR Specialist will develop and maintain a VOD Tracking and Receipt system.

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

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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.
UTILIZATION REVIEW COORDINATOR

UTILIZATION REVIEW COORDINATOR

MOUNTAIN VIEW HOSPITAL LLC

Idaho Falls, ID • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 5 days ago

Mountain View Hospital (Idaho Falls) rating

5.4

Company rating: 5.4 out of 10

Based on 57 frontline employees who took The Breakroom Quiz

895th of 991 rated hospitals

Job description

Mountain View Hospital is looking for a Utilization Review Coordinator to join our team!

JOB SUMMARY: As a member of the Utilization Management Team, the UR
Coordinator helps establish and maintain efficient methods of ensuring the medical necessity and appropriateness of hospital admissions and extended stays. The Utilization Management Team directs the program in accordance with Mountain View Hospital’s mission and strategic goals. The Utilization Management Team directs those activities within the facility which monitor adherence to the hospital’s utilization review plan. The goal of Utilization Management is to continuously improve effective use of hospital services through monitoring patient admissions and stays.


About Mountain View:

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.

Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.


BENEFITS:

Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:

  • Medical, Dental and Vision Insurance
  • Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
  • Retirement Plans (401K with up to 6% match)
  • Earned Quarterly Bonus Program
  • Education Reimbursement Program
  • Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.

Education/Certification: High School Diploma or equivalent. Coding certificate completion is required within 1 year of employment

Experience: Background in medical terminology is helpful. Medical coding and/or insurance experience preferred, however coding certification will be required with in one calendar year of employment


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