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Utilization Reviewer Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

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 ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

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 ...

Stcharles

Utilization Review Specialist

Bend, OR

$27.74 - $41.61/hr

Utilization Review Specialist REPORTS TO POSITION: Manager - Utilization Management DEPARTMENT: Utilization Management DATE LAST REVIEWED: August 2025 OUR VISION: Creating America's healthiest ...

Prime Healthcare

Utilization Review Tech

Lynwood, CA · On-site

$21 - $24.45/hr

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K Who We Are Exact Billing Solutions is a unique team of revenue cycle ...

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How much do utilization reviewer jobs pay per year?

As of Jun 28, 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 evaluates medical records and treatment plans to determine the necessity and appropriateness of healthcare services. They ensure that services comply with insurance policies and industry standards, often using healthcare management software and adhering to regulatory guidelines. This role supports cost containment and quality assurance in healthcare organizations.

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 familiarity with medical coding and documentation are important; some roles may require certification such as the Certified Professional Utilization Review (CPUR).

What jobs pay 2000 a day?

Utilization reviewers typically do not earn $2000 a day; such high daily earnings are more common in specialized roles like senior surgeons, high-level consultants, or certain executive positions. These roles often require advanced certifications, extensive experience, and work in high-paying industries such as healthcare, finance, or law. Most utilization review positions offer salaries that are significantly lower than this daily rate.

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 job makes $10,000 a month without a degree?

A utilization reviewer typically earns between $4,000 and $8,000 per month, depending on experience and location, and usually requires relevant healthcare or insurance knowledge. Jobs that can pay $10,000 a month without a degree include high-level sales, real estate brokers, or certain skilled trades like commercial pilots or specialized technicians, often requiring certifications or extensive experience. These roles often involve self-employment, commissions, or high-demand skills that compensate well without formal college degrees.

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.
More about Utilization Reviewer jobs
What cities are hiring for Utilization Reviewer jobs? Cities with the most Utilization Reviewer job openings:
What states have the most Utilization Reviewer jobs? States with the most job openings for Utilization Reviewer jobs include:
What job categories do people searching Utilization Reviewer jobs look for? The top searched job categories for Utilization Reviewer jobs are:
What are popular job titles related to Utilization Reviewer jobs? For Utilization Reviewer jobs, the most frequently searched job titles are:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in the United States as of June 2026, with employment types broken down into 25% Full Time, 70% Part Time, and 5% Contract. Highlights an 51% Physical, 2% Hybrid, and 47% Remote job distribution, with an average salary of $37,992 per year, or $18.3 per hour.
Utilization Rev Nurse Coord , El Paso Health

Utilization Rev Nurse Coord , El Paso Health

University Medical Center of El Paso

El Paso, TX • On-site

Full-time

Posted 9 days ago

University Medical Center Of El Paso rating

6.8

Company rating: 6.8 out of 10

Based on 35 frontline employees who took The Breakroom Quiz

563rd of 1,003 rated hospitals

Job description

Job Summary
Assists the organization with all activities associated with El Paso Health's (EPH) inpatient Utilization Review Unit. Ensures the Utilization Reviewers conduct a thorough and efficient review of each admission and continued stay while providing high quality health care in a cost effective manner. Ensures the Utilization Management (UM) unit's compliance with all regulatory agencies' rules and regulations, which govern health plan operations. Serves as the primary back up for the inpatient Utilization Reviewer in case of illness, vacation or other needs.
Skills
1. Excellent verbal and written communication and interpersonal skills required as demonstrated by past job experience.
2. Strong analytical, data management and computer skills.
3. Able to work with people of all social, economic, and cultural backgrounds.
4. Flexible, open-minded and adaptable to change.
5. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
6. Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients/families.
7. Bilingual English/Spanish and culturally sensitive highly preferred.
Work Experience
Three years of experience as a Registered Nurse required, preferably in a clinical setting. Strong knowledge of utilization review in Medicaid HMO required, with working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement required. Understanding of pre-acute and post-acute venues of care and community resources.
License/Registration/Certification
Current, active, unrestricted license as to practice as a Registered Nurse in the state of Texas.
Education and Training
Bachelor degree in Nursing required.

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