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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 ...

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

Danville, PA · On-site

Overview Geisinger Behavioral Health in Danville is looking for a Utilization Specialist to join our growing team! PURPOSE STATEMENT: Proactively monitor utilization of services for patients to ...

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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How much do utilization specialist jobs pay per hour?

As of Jun 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 jobs pay $10,000 a month without a degree?

Utilization Specialists typically do not earn $10,000 a month without specialized experience or certifications. High-paying roles 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, skills, and licensing rather than formal education. Success in these fields depends on performance, network, and industry demand.

What jobs pay 2000 a day?

Utilization Specialists typically do not earn $2,000 a day; such high daily rates are usually associated with specialized consulting, executive roles, or highly experienced professionals in fields like finance, law, or technology. These roles often require advanced skills, certifications, or extensive experience and may involve project-based or contract work with high compensation structures.

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 jobs in the US pay 300,000 a year?

Utilization Specialists typically do not earn $300,000 annually; such high salaries are more common in executive, medical, legal, or specialized technical roles. High-paying jobs often require advanced degrees, extensive experience, or certifications, and may involve leadership or highly specialized skills. For most professionals, reaching a $300,000 salary involves senior-level positions or niche expertise.

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 does a utilization specialist do?

A utilization specialist monitors and manages the allocation of resources, such as staff or equipment, to ensure efficient use and compliance with organizational policies. They analyze data, prepare reports, and collaborate with teams to optimize productivity and reduce waste, often using specialized software tools. Strong analytical skills and attention to detail are essential for this role.
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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
Utilization Specialist

Utilization Specialist

Summit BHC

Champaign, IL

Full-time

Posted 8 days ago

Job description

Utilization Specialist | The Pavilion at Williamsburg Place | Williamsburg, Virginia

About the Job:

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes. Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information; Educates hospital staff about requirements and trends.

Roles and Responsibilities:

Performs admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria. Communicates effectively with insurance companies, health maintenance organization (HMOs) and other similar entities for approval of initial or additional inpatient days for treatment. Provides information they need in a logical, concise manner using technical language that accurately describes patient's condition and need for hospitalization.

Communicates directly with physicians and other providers with respect to specific inquires and perceived trends of issues as they relate to utilization management.

Appeals all denials ensuring accuracy of information and effective coordination of correspondence. Initiates, coordinates, and monitors the appeal process. Provides information to physicians to assist them in their role in appeals.

Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.

Maintains accurate documentation and files as it relates to utilization management.

Provides ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

Communicates effectively with co-workers, program, and nursing staff regarding charting deficiencies and problems/issues identified. Follows up in each instance to determine if corrective action was taken. Notifies supervisor if corrective action is not completed.

Coordinates information and findings with the business office to help recognize or resolve possible payment problems.

Monitors patient length of stay and extensions and informs clinical and medical staff on issues that may impact length of stay. Investigates short term length of stays and endeavor to create alternate financial planning which would offer the patient extended days of treatment. Participates in discharge planning as required.

Gathers and develops 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.

Conducts quality reviews for medical necessity and services provided. Facilitates peer review calls between facility and external organizations. Identifies potential review problems and discuss them with multi-disciplinary team and/or administration.

Acts as liaison between managed care organizations and the facility professional clinical staff.

Assists with any problems encountered during on-site or telephone reviews by the third-party payers or review organization, when necessary.

Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field required.

Two or more years of direct clinical experience in a psychiatric or mental health setting required.

Current licensure as an LPN or RN or current clinical professional license or certification, as required, within the state where the facility provides services.

Why The Pavilion at Williamsburg Place?The Pavilion at Williamsburg Place offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. The Pavilion at Williamsburg Place is an EOE.

Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.

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About Summit BHC

Sourced by ZipRecruiter

Summit BHC, based in Franklin, TN, USA, is a recognized leader in the field of addiction treatment and behavioral health care services. The company operates a nationwide network of treatment centers aimed at caring for individuals battling substance abuse and mental health disorders. Summit BHC was established with the mission to provide high-quality, addiction treatment and behavioral health services to those in need throughout the United States. With compassion, dignity, and respect as their core values, they endeavor to instill hope during the journey to recovery and beyond.

Industry

Health care and social assistance

Company size

501 - 1,000 Employees

Headquarters location

Franklin, TN, US

Year founded

2013

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