The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
The utilization specialist in the Emergency Department (ED) will formulate a patient status recommendation for observation or inpatient status, after thorough review of patient assessments during the ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
The utilization specialist in the Emergency Department (ED) will formulate a patient status recommendation for observation or inpatient status, after thorough review of patient assessments during the ...
The utilization specialist in the Emergency Department (ED) will formulate a patient status recommendation for observation or inpatient status, after thorough review of patient assessments during the ...
The utilization specialist in the Emergency Department (ED) will formulate a patient status recommendation for observation or inpatient status, after thorough review of patient assessments during the ...
The utilization specialist in the Emergency Department (ED) will formulate a patient status recommendation for observation or inpatient status, after thorough review of patient assessments during the ...
The utilization specialist in the Emergency Department (ED) will formulate a patient status recommendation for observation or inpatient status, after thorough review of patient assessments during the ...
Utilization Specialist information
See salary details
$15.63 - $19.08
14% of jobs
$21.93 is the 25th percentile. Wages below this are outliers.
$19.08 - $22.53
14% of jobs
$22.53 - $25.98
17% of jobs
The median wage is $27.88 / hr.
$25.98 - $29.44
11% of jobs
$29.44 - $32.89
8% of jobs
$32.89 - $36.34
6% of jobs
$38.93 is the 75th percentile. Wages above this are outliers.
$36.34 - $39.79
7% of jobs
$39.79 - $43.25
7% of jobs
$43.25 - $46.70
5% of jobs
$46.70 - $50.15
5% of jobs
$50.15 - $53.61
5% of jobs
$15
$31
$53
How much do utilization specialist jobs pay per hour?
As of Aug 4, 2026, the average hourly pay for utilization specialist in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.
What skills and qualifications does a utilization specialist need?
To thrive as a Utilization Specialist, you need a background in healthcare or social work, strong analytical abilities, and knowledge of insurance or case management processes, often supported by a relevant degree or certification. Familiarity with utilization review software, electronic health records (EHRs), and medical coding systems like ICD-10 or CPT is typically required. Excellent communication, attention to detail, and problem-solving skills help in coordinating care and advocating for patients. These competencies are crucial for ensuring appropriate resource use, compliance with regulations, and positive outcomes for both patients and healthcare organizations.
How does a utilization specialist collaborate with clinical teams to optimize patient care and resource management?
Utilization Specialists work closely with physicians, nurses, and case managers to review patient cases, ensure appropriate use of healthcare services, and facilitate timely care transitions. They often participate in interdisciplinary meetings, communicate medical necessity to insurance providers, and help develop care plans that balance quality outcomes with cost-effectiveness. This collaboration requires strong communication skills and a thorough understanding of clinical guidelines, making the role both challenging and rewarding for those who enjoy teamwork and problem-solving in a healthcare setting.
Do you need a degree for utilization review?
Utilization specialists typically do not require a specific degree, but many employers prefer candidates with a background in healthcare, nursing, or health administration. Relevant certifications, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Strong analytical skills and knowledge of medical terminology are also important for success in this role.
What is the difference between Utilization Specialist vs Utilization Coordinator?
| Aspect | Utilization Specialist | Utilization Coordinator |
|---|---|---|
| Certifications | Often requires healthcare or insurance-related certifications | Similar certifications, sometimes with additional administrative credentials |
| Work Environment | Healthcare facilities, insurance companies, or managed care organizations | Healthcare settings, insurance providers, or case management teams |
| Job Focus | Analyzing and optimizing resource utilization, ensuring compliance | Coordinating utilization activities, scheduling, and communication |
Utilization Specialists primarily analyze and optimize resource use within healthcare or insurance settings, focusing on compliance and efficiency. Utilization Coordinators handle the coordination and communication aspects of utilization management, often supporting the Specialist's work. Both roles require similar certifications and work environments, but their core responsibilities differ in focus and daily tasks.
What is a utilization specialist?
A utilization specialist is a professional who manages and analyzes the use of resources, such as staff or equipment, to ensure efficiency and cost-effectiveness within an organization. They often work in healthcare, insurance, or staffing industries, using data and software tools to optimize resource allocation and improve operational performance.
More about Utilization Specialist jobs
What job categories do people searching Utilization Specialist jobs look for? The top searched job categories for Utilization Specialist jobs are:
- Medical Utilization Review Physician
- Psychiatric Utilization Review
- Full Time Weekend Utilization Review
- Full Time Utilization Review Specialist
- Utilization Management Ii
- Senior Specialist Cigna Utilization Review
- Insurance Utilization Review
- Utilization Review Salary
- Weekend Utilization Review
- Part Time Bcba Utilization Review
Southwest General Health Center rating
6.9
Based on 46 frontline employees who took The Breakroom Quiz
547th of 1,054 rated hospitals
Job description
Summary
-
POSITION INFORMATION
-
Position summary:
-
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital resources, and quality of care rendered. Accurate and efficient application of screening criteria will be applied to identify and support patients being placed in the appropriate hospital level of care via emergency, scheduled, or direct admission processes. Combines clinical, business, and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification, and education, the Utilization Specialist facilitates the quality of health care delivery in the most cost-effective manner. The Utilization Specialist must be able to demonstrate the knowledge and skills necessary to provide services appropriate to age groups according to specific chronological age, developmental age, and/or psycho-social maturity. The Utilization Specialist will work collaboratively with management, staff, and departments involved in the patients plan of care. The Utilization Specialists responsibility is to collect data and clinical review summaries on patients concurrently for both utilization review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The Utilization Specialist will communicate with physicians, hospital staff, outside agencies such as insurance companies, and patients regarding the assigned level of care and associated resource utilization.
-
-
-
MINIMUM QUALIFICATIONS
-
Education:
-
Graduation from an accredited School of Nursing. BSN graduate preferred.
-
-
Required length and type of experience:-
Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management)
-
Previous Care Management, Case Management or Utilization Management Experience preferred
-
Previous experience with screening criteria (i.e. Interqual, MCG) preferred
-
Excellent critical thinking and communication skills
-
Strong computer skills
-
-
Required licensure, certification or registry:-
Current licensure by Ohio State Board of Nursing.
-
ACM/CCM Certification helpful
-
-
What Southwest General Health Center employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Southwest General
Sourced by ZipRecruiter
Industry
Hospitals
Company size
1,001 - 5,000 Employees
Headquarters location
Middleburg Heights, OH, US
Year founded
1920