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Utilization Specialist Jobs (NOW HIRING)

Southwest General

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 ...

Southwest General

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 ...

Southwest General

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 ...

Southwest General

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 ...

Kheir-Clinic-

Utilization Specialist

Lancaster, CA · On-site

$65 - $75/hr

The Utilization Specialist will work closely with the clinical teams, Director of Patient Services, and external stakeholders to support the delivery of high-quality care in alignment with the ...

New

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

$60 - $80/hr

Utilization Specialist page is loaded## Utilization Specialistlocations: The Pavilion at Williamsburg Placetime type: Full timeposted on: Posted Todayjob requisition id: JR124748Utilization ...

Kheir Clinic

Utilization Specialist

Los Angeles, CA · On-site

$64K - $75K/yr

The Utilization Specialist will work closely with the clinical teams, Director of Patient Services, and external stakeholders to support the delivery of high-quality care in alignment with the ...

Summit BHC

Utilization Specialist

Champaign, IL · On-site

Utilization Specialist | The Pavilion at Williamsburg Place | Williamsburg, Virginia About the Job: The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

Utilization Specialist | The Pavilion at Williamsburg Place | Williamsburg, Virginia About the Job: The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ...

Summit BHC

Utilization Specialist - Acute

Williamsburg, VA · On-site

$24 - $28/hr

Utilization Specialist - Acute | The Pavilion at Williamsburg Place | Williamsburg, Virginia About the Job: About the Job: The Pavilion is looking for a Utilization Specialist to join our team! -Pay ...

Summit BHC

Utilization Specialist - Acute

Champaign, IL · On-site

$3.0K/yr

Utilization Specialist - Acute | The Pavilion at Williamsburg Place | Williamsburg, Virginia About the Job: About the Job: The Pavilion is looking for a Utilization Specialist to join our team! -Pay ...

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Utilization Specialist information

See salary details

$15

$31

$53

How much do utilization specialist jobs pay per hour?

As of Sep 5, 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.

What is the difference between Utilization Specialist vs Utilization Coordinator?

AspectUtilization SpecialistUtilization Coordinator
CertificationsOften requires healthcare or insurance-related certificationsSimilar certifications, sometimes with additional administrative credentials
Work EnvironmentHealthcare facilities, insurance companies, or managed care organizationsHealthcare settings, insurance providers, or case management teams
Job FocusAnalyzing and optimizing resource utilization, ensuring complianceCoordinating 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, staffing, or project management environments, using data and software tools to optimize resource allocation.
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What job categories do people searching Utilization Specialist jobs look for?

The top searched job categories for Utilization Specialist jobs are:

Utilization Specialist jobs near you
Infographic showing various Utilization Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 85% Physical, 2% Hybrid, and 13% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.

UTILIZATION SPECIALIST

Southwest General

Middleburg Heights, OH • On-site

Full-time

Re-posted 6 days ago

Southwest General Health Center rating

6.9

Company rating: 6.9 out of 10

Based on 46 frontline employees who took The Breakroom Quiz

545th of 1,065 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

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