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Utilization Reviewer Jobs (NOW HIRING)

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 ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing an intentionally different approach to mental health and well-being. We are a combination of bricks ...

GRO Community

Utilization Review Manager

Chicago, IL · On-site

Utilization Review Manager Location: Chicago Job Type: Full-Time Reports to: Director of Revenue Cycle Manager; In Direct Reporting to Chief Clinical Officer Direct Reports: none, subject to change ...

GRO Community

Utilization Review Manager

Chicago, IL

Utilization Review Manager Location: Chicago Job Type: Full-Time Reports to: Director of Revenue Cycle Manager; In Direct Reporting to Chief Clinical Officer Direct Reports: none, subject to change ...

GRO Community

Utilization Review Manager

Chicago, IL · On-site

Utilization Review Manager Location: Chicago Job Type: Full-Time Reports to: Director of Revenue Cycle Manager; In Direct Reporting to Chief Clinical Officer Direct Reports: none, subject to change ...

UHS

Utilization Review Coordinator

Augusta, GA · On-site

The Utilization Review Coordinator opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care; ensuring ...

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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.
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

Utilization Review Representative

Wyoming Valley Behavioral Hospital

Kingston, PA • On-site

$25 - $35/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

New

Job description

) As Wyoming Valley Behavioral Health continues to expand, we're excited to add an experienced full-time Utilization Review Representative to our growing Utilization Review department. The person will be responsible for reviewing and analyzing patient care to ensure the appropriate use of resources, adherence to clinical guidelines, and compliance with regulatory requirements.
Responsibilities:
• Conduct thorough reviews of patient records and treatment plans to assess the necessity and appropriateness of medical services and interventions.
• Evaluate clinical documentation to ensure it meets established standards and guidelines for care.
• Collaborate with healthcare providers to discuss treatment plans and recommend modifications as needed to optimize patient outcomes and resource utilization.
• Prepare and maintain detailed documentation of reviews, including rationale for decisions and recommendations for care adjustments.
• Serve as a liaison between the facility and insurance companies or other third party payers to manage authorizations and claims.
• Prepare and present reports on utilization metrics, including patterns, outcomes, and recommendations for process improvements.
Education:
• Associate's degree or higher in Nursing, Healthcare Administration or a related field
Qualifications:
• Minimum of 1-2 years of experience in a healthcare setting, with a strong background in utilization review, case management, or clinical nursing.
• Licensed RN/LPN preferred
• Knowledge of clinical guidelines, regulatory requirements, and healthcare reimbursement processes.
• Excellent analytical skills and attention to detail, with the ability to review and interpret complex clinical information.
• Strong communication and interpersonal skills, with the ability to work collaboratively with healthcare professionals and external stakeholders.
• Proficient in electronic health record (EHR) systems and utilization review software.
• Certification in Utilization Review or related field (e.g., URAC, CCM) is a plus.
Exciting Benefits Await You:
• Attractive Compensation: Enjoy competitive pay that truly values your contributions.
• Generous Paid Time Off: Recharge and prioritize your well-being with ample PTO.
• 401(k) Plan: Secure your financial future with our strong retirement plan.
• Flexible Daily Pay: Access your earnings whenever you need them.
• Comprehensive Benefits Package: Benefit from a wide range of options, including dental, health, vision, and disability insurance.
• Wellness Program Access: Prioritize your health with resources designed to support your well-being.
• Inclusive Workplace Culture: Thrive in a supportive environment that champions diversity and collaboration.
• Career and Educational Development: Unlock your potential with numerous opportunities for growth and advancement.
• Comprehensive Onboarding and Professional Development Programs: Expertly crafted to cultivate growth and significantly enhance essential skills, paving the way for sustained success and excellence.
Salary/ Wage Range
Compensation for the role will depend on a number of factors, including a candidate's qualifications, skills, competencies and experience and may fall outside of the range shown.
EEO Statement
We are committed to maintaining a diverse and inclusive workplace. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for our job opportunities.

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