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Utilization Reviewer Jobs in Edmond, OK (NOW HIRING)

UHS

UR Coordinator

Oklahoma City, OK · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Responsibilities The Utilization Review Coordinator evaluates patient medical records to determine severity of patient's illness and the appropriateness of level of care. Serves as liaison for ...

Humana

Compliance UM Nurse (Wed - Sun)

Oklahoma City, OK · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Edmond, OK

Utilization Reviewer information

See Edmond, OK salary details

$26.2K

$32.1K

$37.2K

How much do utilization reviewer jobs pay per year?

As of Aug 13, 2026, the average yearly pay for utilization reviewer in Edmond, OK is $32,149.00, according to ZipRecruiter salary data. Most workers in this role earn between $28,800.00 and $35,500.00 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.
More about Utilization Reviewer jobs
What are popular job titles related to Utilization Reviewer jobs in Edmond, OK? For Utilization Reviewer jobs in Edmond, OK, the most frequently searched job titles are:
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What cities near Edmond, OK are hiring for Utilization Reviewer jobs? Cities near Edmond, OK with the most Utilization Reviewer job openings:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Edmond, OK as of August 2026, with employment types broken down into 2% As Needed, 84% Full Time, 12% Part Time, and 2% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $32,149 per year, or $15.5 per hour.

Utilization Review Specialist

Lifepoint Health

Oklahoma City, OK • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 6 days ago

LifePoint Health rating

5.9

Company rating: 5.9 out of 10

Based on 272 frontline employees who took The Breakroom Quiz

758th of 887 rated healthcare providers

Job description

Your experience matters 

At Oakwood Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

How you'll contribute 
Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to managed care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient's stay and assists the treatment team in understanding the insurance company's requirements for continued stay and discharge planning. 
 

Essential Functions

  • Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed services

  • Completes pre and re-certifications for inpatient and outpatient services. Reports appropriate denial, and authorization information to designated resource.

  • Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations.

  • Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.

  • Works with DON to ensure documentation requirements are met.

  • Ensure appeals are completed thoroughly and on a timely basis.

  • Interface with managed care organizations, external reviews, and other payers.

  • Communicate with physicians to schedule peer to peer reviews.

  • Accurately report denials.

  • Other duties as assigned.

What we offer 

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers: 

  • Comprehensive medical, dental, and vision plans, plus flexible-spending and health- savings accounts  
  • Competitive paid time off 
  • Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage 
  • Tuition reimbursement, loan assistance, and 401(k) matching  
  • Employee assistance program including mental, physical, and financial wellness 
  • Professional development and growth opportunities

Qualifications and requirements 
Education: Bachelor's degree required. Master's degree preferred.
Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
License: Current unencumbered clinical license strongly preferred.
Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime.

About Us
Oakwood Springs is a 72 - bed hospital located in Oklahoma City, OK, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters.

EEOC Statement

Oakwood Springs is an Equal Opportunity Employer.  Oakwood Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.

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About LifePoint Health

Sourced by ZipRecruiter

Lifepoint Health serves patients, clinicians, communities and partners across the healthcare continuum. Our diversified healthcare delivery network extends from coast to coast, consisting of community hospitals, rehabilitation and behavioral health hospitals, and additional sites of care.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Brentwood, TN, US

Year founded

1999

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