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Utilization Specialist Jobs (NOW HIRING)

Summit BHC

Utilization Specialist

Champaign, IL

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

Acadia Healthcare

Utilization Specialist

Danville, PA · On-site

Overview Utilization Specialist - Geisinger Behavioral Health Center Danville Join our team as a Utilization Specialist and help ensure patients receive the care they need while supporting effective ...

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 ...

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 ...

Acadia Healthcare

Utilization Specialist

Henderson, NV · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the ...

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Utilization Specialist information

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$15

$31

$53

How much do utilization specialist jobs pay per hour?

As of Jul 14, 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 degree do I need for utilization review?

Utilization specialists typically need at least a bachelor's degree in healthcare administration, nursing, or a related field. Relevant certifications, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Strong analytical skills and knowledge of medical coding and insurance processes are also important.

What jobs pay 4000 a week without a degree?

Utilization Specialists typically do not earn $4,000 per week without specialized experience or certifications. High-paying roles that can reach this level without a degree often include sales, real estate, or certain skilled trades like commercial driving or technical trades, which rely more on skills and licensing than formal education. These jobs may require on-the-job training, licensing, or proven performance to achieve such earnings.

What are the key skills and qualifications needed to thrive as a Utilization Specialist, and why are they important?

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.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) position is often considered a good entry-level job in healthcare, as it requires basic administrative skills, such as scheduling, data entry, and patient communication. It provides experience in medical environments and can serve as a stepping stone to more advanced healthcare roles, often requiring certification or training programs. However, job responsibilities and advancement opportunities vary by employer and location.

What does a utilization specialist do?

A utilization specialist monitors and manages the use of resources, such as staff or equipment, to ensure efficiency and cost-effectiveness within an organization. They analyze data, optimize workflows, and may use tools like spreadsheets or specialized software to track utilization rates 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:
Utilization Specialist jobs near you
Utilization Specialist

Utilization Specialist

Lakeland Behavioral Health System

Springfield, MO • On-site

$18 - $22/hr

Full-time

Posted 21 days ago

Job description

Overview

Utilization Specialist 

Lakeland Behavioral Health System

We're Hiring a Utilization Specialist!

Lakeland Behavioral Health System is looking for a Utilization Specialist to help support patient care and keep our clinical teams moving.

Monday - Friday

8am-4pm or flexible 

Hourly: $18.00 - $22.00

What You'll Do

  • Coordinate with managed care partners
  • Review insurance requirements
  • Track length of stay
  • Compile key utilization data
  • Conduct medical necessity reviews
  • Lead appeals & support precerts
  • Train staff on documentation standards
  • Make an impact. Support great care. Grow your career.

Lakeland has spent more than 30 years creating a warm, supportive place where people can find real hope and healing. Rooted in clinical excellence and evidencebased care, our team is dedicated to helping every individual feel seen, supported, and truly cared for. With a wide range of therapeutic opportunities, we empower each person to move toward lasting wellness in a compassionate environment that feels like a community. Apply today!

PURPOSE STATEMENT: 

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  

Responsibilities

ESSENTIAL FUNCTIONS: 

  • Act as liaison between managed care organizations and the facility professional clinical staff. 
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. 
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.  
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. 
  • Conduct quality reviews for medical necessity and services provided.   
  • Facilitate peer review calls between facility and external organizations.  
  • Initiate and complete the formal appeal process for denied admissions or continued stay.  
  • Assist the admissions department with pre-certifications of care.  
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. 

OTHER FUNCTIONS:  

  • Perform other functions and tasks as assigned. 
Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

  • Required Education: High school diploma or equivalent. 
  • Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. 
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred 

LICENSES/DESIGNATIONS/CERTIFICATIONS:  

  • Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. 
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.   
  • First aid may be required based on state or facility requirements. 

 

ADDITIONAL REGULATORY REQUIREMENTS: 

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances  (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

#LI-LBHS

AHPILOT

#LI-HM1

Employment Type: FULL_TIME

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