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Utilization Reviewer Jobs in Erie, PA (NOW HIRING)

Pyramid Healthcare

Counselor

Erie, PA · On-site

Complete insurance and utilization reviews as needed. * Attend supervision, staff meetings, and required company trainings. * Maintain an active caseload and ensure all client documentation is ...

Highmark Health

Physician Advisor - Erie, Pa

Erie, PA · On-site

... utilization management. * Receives daily report from Nursing Service (Bed Management) and Case Management on all observation cases. * Reviews the status of observation cases, facilitates use of ...

Highmark Health

Physician Advisor - Erie, Pa

Erie, PA · On-site

... utilization management. * Receives daily report from Nursing Service (Bed Management) and Case Management on all observation cases. * Reviews the status of observation cases, facilitates use of ...

Highmark Health

Physician Advisor - Erie, Pa

Erie, PA · On-site

... utilization management. * Receives daily report from Nursing Service (Bed Management) and Case Management on all observation cases. * Reviews the status of observation cases, facilitates use of ...

Encompass Health

Case Manager

Erie, PA · On-site

$19.50 - $25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Erie, PA

Utilization Reviewer information

See Erie, PA salary details

$30K

$36.8K

$42.6K

How much do utilization reviewer jobs pay per year?

As of Sep 1, 2026, the average yearly pay for utilization reviewer in Erie, PA is $36,808.00, according to ZipRecruiter salary data. Most workers in this role earn between $32,900.00 and $40,700.00 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

What are popular job titles related to Utilization Reviewer jobs in Erie, PA?

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

What job categories do people searching Utilization Reviewer jobs in Erie, PA look for?

The top searched job categories for Utilization Reviewer jobs in Erie, PA are:

What cities near Erie, PA are hiring for Utilization Reviewer jobs?

Cities near Erie, PA with the most Utilization Reviewer job openings:

Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Erie, PA as of August 2026, with employment types broken down into 2% As Needed, 77% Full Time, 18% Part Time, 2% Temporary, and 1% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $36,808 per year, or $17.7 per hour.

Counselor

Pyramid Healthcare

Erie, PA • On-site

Full-time

Re-posted 29 days ago

Pyramid Healthcare rating

4.8

Company rating: 4.8 out of 10

Based on 58 frontline employees who took The Breakroom Quiz

878th of 896 rated healthcare providers

Job description

$1500 Sign-on Bonus Available

Schedule: Full-Time 7:30-4pm

Our Erie Outpatient Program provides a supportive, therapeutic environment where clients can build strength, develop skills, and reclaim their overall health and well-being. We are currently seeking a full-time Counselor to join our dedicated outpatient clinical team. If you are passionate about helping individuals overcome challenges and achieve lasting recovery, we encourage you to apply.

Bilingual candidates are preferred but not required.

Position Overview

The Counselor plays a key role in delivering individual, group, and family therapy services within our outpatient program. This position also supports daily clinical operations, intake processes, treatment planning, and documentation requirements to ensure the highest level of client care.

Key Responsibilities
  • Support daily clinical operations, including assessments, utilization reviews, and therapeutic services.
  • Provide individual counseling, group therapy, and family therapy to clients participating in outpatient treatment.
  • Conduct client intake assessments and assist in developing individualized treatment plans.
  • Complete insurance and utilization reviews as needed.
  • Attend supervision, staff meetings, and required company trainings.
  • Maintain an active caseload and ensure all client documentation is completed accurately and in a timely manner.
  • Assist the Program Director with program coverage and service needs.
  • Perform clerical duties related to maintaining organized and compliant client records.
  • Actively listen to clients and support them throughout their treatment journey.
  • Maintain a safe, structured, and therapeutic environment, including providing crisis intervention when appropriate.
  • Complete all required trainings and maintain mandatory continuing education requirements.
  • Perform additional duties as assigned by leadership.
Education & Experience Requirements

Applicants must meet one of the following qualifications:

  • Master's degree in Psychology, Counseling, Social Work, or a related behavioral health field; OR
  • Bachelor's degree in Psychology, Counseling, Social Work, or a related behavioral health field; OR
  • Current CADC or CAADC certification.

Note: This position offers opportunities to gain supervised clinical experience and advance within the organization.

Preferred Skills & Qualities
  • Experience providing clinical services for mental health, substance use, or co-occurring disorders.
  • Strong understanding of ethical and professional standards in client care and teamwork.
  • Knowledge of HIPAA regulations, state licensing requirements, and CARF standards.
  • Ability to remain calm and effective during crisis situations.
  • Strong critical-thinking and problem-solving skills.
  • Flexibility, adaptability, and reliability in a fast-paced clinical environment.
  • Excellent written and verbal communication skills.
Why Join Pyramid Healthcare?
  • Join a mission-driven organization dedicated to helping individuals achieve long-term recovery.
  • Make a meaningful impact in a respected outpatient treatment program.
  • Grow your clinical expertise in a supportive, collaborative environment.

If you are passionate about helping individuals achieve lasting recovery and want to grow your career in Substance Use Disorder treatment, we invite you to apply today.

 ***Due to the nature of behavioral healthcare work and our responsibility to ensure client safety, candidates selected for hire must successfully pass a criminal background check, drug screening, and any required statemandated clearances. Employment is contingent upon meeting all screening requirements in accordance with federal, state, and accreditingbody regulations.***

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