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Utilization Reviewer Jobs in Ohio (NOW HIRING)

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Utilization Reviewer information

See Ohio salary details

$29.5K

$36.1K

$41.8K

How much do utilization reviewer jobs pay per year?

As of Aug 9, 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 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.

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.
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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 RN, Behavioral Health

Trinity Health System

Steubenville, OH • On-site

Part-time

Re-posted 9 days ago

Job description

JOB SUMMARY
  • Performs the four key functions of case management: Utilization review, Resource management, Managing the continuum of care, and Clinical documentation management. Responsible for facilitating appropriate length of stay and reimbursement for all hospital admissions. Promotes quality care through collaboration with all team members.

QUALIFICATIONS
  • Education
    • Registered Nurse; Licensure: Ohio Nursing License.
  • Training and Experience
    • 3 years clinical nursing experience in an acute care setting preferred. Ability to assess medical necessity and progress by chart review.
    • Preferred: Certification in Case Management. Computer literacy including operation and software application. Experience in utilization review, discharge planning, case management, or quality improvement.
  • Health and Background Requirements
    • Employment contingent upon successful completion of:
      • Physical
      • Background Check
    • Must be physically able to perform all job duties as assigned.

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