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Utilization Reviewer Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

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Utilization Reviewer information

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How much do utilization reviewer jobs pay per year?

As of Jul 20, 2026, the average yearly pay for utilization reviewer in the United States is $37,992.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,000.00 and $42,000.00 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.
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Utilization Reviewer jobs near you
Utilization Reviewer (LPN)

Utilization Reviewer (LPN)

Healthcare Support Staffing

Tampa, FL

$19 - $26/hr

Other

Re-posted 16 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Are you an experienced LPN looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!

Daily Responsibilities:

The Utilization Review LPN is responsible for the pre-certification of determined procedures utilizing the organizations Plan approved criteria. The position helps manage healthcare costs by influencing patient care decision making through case-by-case assessments of the care prior to it's delivery.

 ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Evaluates requested services following Plan approved criteria.
  • Demonstrates effective communication methods and skills, using lines of authority appropriately.
  • Establishes a relationship with providers in order to determine/provide needed services for members
  • Arranges discharge planning services prior to pre-planned admissions when available.
  • Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
  • Maintains accurate record of pre-certification decisions.
  • Performs decisions within time frames required by regulatory agencies.
  • Adheres to quality standards and confidentiality policies and procedures.
  • Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
  • Adapts to changes in policies, procedures, new techniques and additional responsibilities.


Qualifications

Active FL LPN license with a minimum of 2 years varied clinical experience required. 

Managed Care experience (utilization review, pre-certification, concurrent review) is preferred. 

Proficiency in MS Office with basic computer and typing skills.

Additional Information

Advantages of this Opportunity: 

Competitive salary $19 - $26/hr+ (based off experience)

Excellent Medical Benefits Offered

Growth potential 

Fun and positive work environment

If you are interested in applying to this position please call Jonathan Comstock at (407) 478-0332 Ext. 133

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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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