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Utilization Reviewer Jobs in Minnesota (NOW HIRING)

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Provides support and review of medical claims and utilization practices. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go ...

Ourhrconnect

Provides support and review of medical claims and utilization practices. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Minnesota

Utilization Reviewer information

See Minnesota salary details

$30.4K

$37.2K

$43.1K

How much do utilization reviewer jobs pay per year?

As of Jul 20, 2026, the average yearly pay for utilization reviewer in Minnesota is $37,210.00, according to ZipRecruiter salary data. Most workers in this role earn between $33,300.00 and $41,100.00 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.

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.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a healthcare-related degree such as nursing, health administration, or a related field. Relevant experience in healthcare or insurance, strong analytical skills, and knowledge of medical coding and documentation are important; some employers may also require certification such as the Certified Professional Medical Auditor (CPMA).

Is utilization review a stressful job?

Utilization reviewers often work in a fast-paced environment where accuracy and attention to detail are essential, which can contribute to job stress. The role may involve managing high caseloads and strict deadlines, but stress levels vary depending on the work setting and individual coping strategies.

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.

Is utilization review work from home?

Utilization reviewer jobs can often be performed remotely, especially in organizations that utilize electronic health records and telecommunication tools. Many employers offer work-from-home options for this role, which typically requires strong analytical skills, knowledge of healthcare policies, and certification in case management or utilization review. However, some positions may require on-site presence depending on company policies and regulatory requirements.

What jobs pay 4000 a week without a degree?

Utilization reviewers typically do not earn $4,000 a week without a degree; this role usually requires healthcare or insurance industry experience and certifications. High-paying jobs that can reach this level without a degree often include sales, real estate, or skilled trades like plumbing or electrical work, which rely on experience and skills rather than formal education.
More about Utilization Reviewer jobs
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What cities in Minnesota are hiring for Utilization Reviewer jobs? Cities in Minnesota with the most Utilization Reviewer job openings:
What are popular job titles related to Utilization Reviewer jobs in MN? For Utilization Reviewer jobs in MN, the most frequently searched job titles are:
Utilization Reviewer jobs near you
Nurse Care Manager & Utilization Review

Nurse Care Manager & Utilization Review

Gillette Children's Specialty Healthcare

Saint Paul, MN • On-site

$76K - $114K/yr

Full-time

Medical, Retirement, PTO

Posted 3 days ago

New

Job description

We are currently hiring for a Nurse Care Manager position! This is a .8 FTE (32 hours/week) Monday - Friday, 8am - 4:30pm at our Main St. Paul Campus. Position supports all inpatient units with primary coverage for Neurosciences, Orthopedic/Surgical, PICU, and Adult units.
Purpose of position
Performs preadmission, concurrent, and retrospective reviews of by direct contact with inpatients, clinical staff, and the medical record using pre-established, objective, quality of care, coding, and medical necessity criteria to monitor patient care rendered. Provides decision support by communicating findings to nursing, social work, providers, or others. Negotiates reimbursement directly with payers or refers complex cases to manager or designee.
Provides inpatient care management for identified hospitalized medical and surgical patients. Collaborates with the interdisciplinary care team to facilitate the achievement of optimal outcomes in a cost effective manner. Negotiates and coordinates services and resources needed to reach the identified goals. Continuously evaluates the effectiveness of the care management plan with the physician and rest of the healthcare team and modifies as needed. Communicates with the patient, family and healthcare team regarding progress on plan.
Compensation & Benefits Information
The annual salary range for this opportunity is $76,177.92 to $114,233.60, with a median salary of $95,205.76. Pay is dependent on several factors including relevant work experience and internal equity. Salary is just one component of the compensation package for employees. Gillette supports career progression and offers a competitive benefits package, including a retirement saving match, tuition and certification reimbursement, paid time off, and health and wellness benefits for .5 FTE and above.
Core Responsibilities and Duties
Performs and documents preadmission, concurrent, and retrospective reviews of patient clinical records using pre-established, objective criteria Enhances performance improvement and quality outcomes, and ensures safe patient care.
  • Completes admission, observation status and continued stay discharge reviews and documents reviews in the electronic health record.
  • All reviews will be completed within 24 hours or on the first business day after admission.
  • Works collaboratively with medical staff and providers to determine and assign proper status for all inpatients.
  • Monitors incomplete status reports and completes follow up.
  • Provides insurance utilization review and care management staff with routine updates on patient's condition and progress.

Serves as internal consultant regarding utilization review and management of patients within the hospital setting.
  • Performs daily interprofessional rounds to coordinate the optimal patient care experience.
  • Facilitates daily discussion and tracking of discharge goals, anticipated discharge dates and progress towards the goals.
  • Works collaboratively with the health care team to help break down any barriers to prevent a planned discharge of a patient.
  • Assists team member is assessing proper status of patient and reviewing documentation to support the proper status.

Coordinates, monitors and reviews other activities as needed.
  • If insurance denies payment for care, works collaboratively with medical staff and family to appeal decision and advocate for patient needs.

Participates in activities that promote professional growth and quality improvement.
  • Monitors, analyzes and develops plans to improve key metrics for process improvement as agreed upon by the UR/UM committee on an annual basis
  • Completes all annual education requirements within the last evaluation cycle; demonstrate knowledge by performing all aspects of job in accordance with safety policies.
  • Ongoing training to maintain competence in utilization review and management skills.
  1. Engages in the practice of Financial Stewardship.
  • Analyzes data and make recommendations to change medical practice to enhance efficiency.

Acts as liaison between fiscal and clinical areas and provides data to maximize reimbursement.
Qualifications
Required
  • Current RN license through the MN Board of Nursing
  • Bachelor's degree, preferably in Nursing or other healthcare related field
  • Current BLS certification (Basic Life Support through the American Heart Association) or obtain within 90-days of hire.
  • Must be interested in working with people with short term or long term disabilities that begin in childhood
  • A minimum of 5 years recent clinical experience

Preferred
  • Master's degree in nursing or related field
  • Certification in specialty area i.e. URAC (Utilization Review and Accreditation Commission) certification
  • Knowledge and understanding of utilization review and management
  • Leadership experience

Knowledge, Skills and Abilities
  • Excellent customer service skills
  • Knowledge and understanding of utilization review and management concepts and practice
  • Group process and change management knowledge and skills
  • Strong leadership skills and works well with physician and members of the interprofessional team members
  • Flexible, organized and attention to detail

At Gillette Children's, we foster a culture where every team member feels a sense of belonging and purpose. We are dedicated to building an environment where all feel welcomed, respected, and supported. Our values are embedded at the heart of our culture. We act first from love, embrace the bigger picture, and work side-by-side with our patients, families, and colleagues to help every child create their own story. Together, we work to ensure patients of all backgrounds and abilities reach their full potential.
Gillette Children's is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of an individual's race, color, creed, sex, religion, national origin, age, disability, marital status, familial status, genetic information, status with regard to public assistance, sexual orientation or gender identity, military status or any other class protected by federal, state or local laws.
Gillette Children's is a global beacon of care for patients with brain, bone and movement conditions that start in childhood. Our research, treatment and supportive technologies enable every child to lead a full life defined by their dreams, not their diagnoses.
To learn more about working at Gillette Children's, please visit https://www.gillettechildrens.org/careers.
Gillette Children's participates in the U.S. Department of Homeland Security (DHS) E-Verify program which is an internet-based employment eligibility verification system operated by the U.S. Citizenship and Immigration Services. If E-Verify cannot confirm that you are authorized to work, Gillette will give you written instructions and an opportunity to contact DHS or the Social Security Administration (SSA) to resolve the issue before Gillette takes any further action. Please visit https://www.e-verify.gov/ for further details regarding E-Verify.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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