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Utilization Reviewer -Behavioral Health

Conway, SC · On-site

Responsibilities Utilization Reviewer Opportunity! Lighthouse Behavioral Health Hospital, located near beautiful Myrtle Beach, SC, treats adolescents, adults and senior adults in need of psychiatric ...

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How much do utilization reviewer jobs pay per year?

As of Jun 5, 2026, the average yearly pay for utilization reviewer in the United States is $37,992.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,000.00 and $42,000.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

What jobs make $3,000 a month without a degree?

Utilization reviewers typically earn between $3,000 and $4,500 per month, depending on experience and location, and often do not require a degree. Many related roles in healthcare or insurance involve reviewing claims or data, with some positions offering on-the-job training and certifications. Other jobs that can pay around $3,000 monthly without a degree include administrative assistants, sales representatives, and certain skilled trades, though wages vary by region and industry standards.

How does a Utilization Reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a Utilization Reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What Does a Utilization Reviewer Do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a Utilization Reviewer, and why are they important?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.
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Utilization Reviewer jobs near you
Utilization Reviewer - Full Time

Utilization Reviewer - Full Time

Rehabilitation Hospital of Indiana

Indianapolis, IN • On-site

Full-time

Retirement

Posted 14 days ago

Job description

The Rehabilitation Hospital of Indiana (RHI) is nationally ranked among the Best Hospitals for Rehabilitation by U.S. News and World Report for 2025-2026 and the Best Rehabilitation Hospital in Indiana for the third year in a row. RHI provides high quality, evidence-based rehabilitation services to those facing life-changing injuries or illness. RHI is the only Traumatic Brain Injury (TBI) Model System in the state of Indiana and one of only 16 in the U.S We offer a competitive compensation and benefits package, along with a 401k match and tuition reimbursement program.

Summary:

The Utilization Reviewer contributes to assessment and planning by performing a thorough review of the total resources available to patient pre and post-discharge from rehabilitation care. The Utilization Reviewer collaborates with the payer and rehabilitation team to ensure a successful transition to the discharge setting and or goal achievement, and durability of outcome.

Essential Functions

  • Assesses all of patient's payer sources for rehabilitation course, determines resources available for patient, and ensures maximal use of available health coverage resources for each patient.
  • Completes pre-certification and prior authorization timely for admission and or services.
  • Documents all insurance information appropriately on forms and in computer system as applicable.
  • Functions as liaison with payer representatives to manage the rehabilitation process in keeping with the patient's financial resources, including verification of benefits for this and future settings.
  • Completes retro authorizations as applicable and ensures follow through relative to authorizations for all services through the complete revenue cycle.
  • Other duties as assigned.

Education and Experience

  • Greater than 2 years of UR experience with a strong clinical background and competence with a rehabilitation population.
  • Bachelor's degree in related field with 3-5 years' experience
  • LPN or RN experience preferred

Hours

  • Monday - Friday (8:30am-5:00pm)

The Rehabilitation Hospital of Indiana is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, or any other characteristic protected by law.