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Utilization Reviewer Jobs in Ohio (NOW HIRING)

Prime Time Healthcare

Utilization Review

Cleveland, OH · On-site

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

Nationwide Children's Hospital

Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines. * Communicates with healthcare teams and third ...

talent4health

RN - Utilization Review

Cleveland, OH · On-site

$2.2K/wk

Details Client Name Southwest General Hospital Center Southwest General Health Center Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 18807560 Job Title RN - ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Ohio

Utilization Reviewer information

See Ohio salary details

$29.5K

$36.1K

$41.8K

How much do utilization reviewer jobs pay per year?

As of Sep 1, 2026, the average yearly pay for utilization reviewer in Ohio is $36,119.00, according to ZipRecruiter salary data. Most workers in this role earn between $32,300.00 and $39,900.00 per year, depending on experience, location, and employer.

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?

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.

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 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 do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can enhance job prospects, and strong knowledge of healthcare policies and documentation is essential.

Is utilization review a good job?

Utilization reviewers evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires attention to detail, knowledge of healthcare policies, and sometimes certification, with typical schedules being standard business hours. It can offer stable employment and opportunities for advancement in healthcare administration.
More about Utilization Reviewer jobs

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For Utilization Reviewer jobs in Ohio, the most frequently searched job titles are:

What job categories do people searching Utilization Reviewer jobs in Ohio look for?

The top searched job categories for Utilization Reviewer jobs in Ohio are:

What cities in Ohio are hiring for Utilization Reviewer jobs?

Cities in Ohio with the most Utilization Reviewer job openings:

What are popular job titles related to Utilization Reviewer jobs in OH?

For Utilization Reviewer jobs in OH, the most frequently searched job titles are:

Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Ohio as of August 2026, with employment types broken down into 66% Full Time, 17% Part Time, and 17% Nights. Highlights an 100% In-person job distribution, with an average salary of $36,119 per year, or $17.4 per hour.

Utilization Review

Cleveland, OH • On-site

Prime Time Healthcare
Recruiting and Staffing Services • 51 - 200 employees
Learn more about Prime Time Healthcareexternal

Other

Medical, Dental, Vision, Retirement

This job post has expired today. Applications are no longer accepted.

Job description

Now Hiring: RN Utilization Review - Middleburg Heights, OH

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 Middleburg Heights, OH and make a real impact in patient care!

In this role, you'll be at the forefront of healthcare, delivering top-notch care with precision and compassion. As an integral part of our team, you'll collaborate closely with fellow healthcare professionals, ensuring every patient receives the highest level of care possible.

If you're ready to elevate your career and make a difference in the lives of others, apply today!

At Prime Time Healthcare, we offer competitive compensation along with a large range of benefits including:

  • Competitive compensation and weekly direct deposit
  • Compliance Support Specialist & Onboarding Assistance
  • Dedicated recruiter for personalized support
  • Paid, safe, pet-friendly lodging (if applicable)
  • Round-the-clock customer support 24/7
  • Unlimited referral bonus up to $750
  • Medical, Vision & Dental insurance
  • 401(k) Matching Program
  • Flexible Schedules
  • Travel Discounts

Prime Time Healthcare, LLC is an Equal Opportunity Employer (EOE).

*Estimated pay and benefits packages are on a per facility basis and may change with market conditions. Exact pay and benefits package will be negotiated with Prime Time Healthcare and may vary with several factors including but not limited to, guaranteed hours, travel distance, demand, eligibility, etc.

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About PrimeTime Healthcare

Sourced by ZipRecruiter

PrimeTime Healthcare, based in Omaha, NE, US, is a leading provider of staffing solutions in the healthcare industry. According to information accessed from their official website, primetimehealthcare.com, the company specializes in placing high-quality healthcare professionals into temporary and travel positions across a vast network of healthcare facilities nationwide. Founded in 2012, PrimeTime Healthcare quickly established a reputation for customer-focused and result-oriented services, earning it a place on Staffing Industry Analyst’s fastest-growing staffing companies list.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Omaha, NE, US

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