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Utilization Specialist Jobs (NOW HIRING)

Acadia Healthcare

Utilization Specialist

Magee, MS · On-site

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

Acadia Healthcare

Utilization Specialist

Conway, AR · On-site

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

Acadia Healthcare

Utilization Specialist

Wesley Chapel, FL · On-site

$55 - $75/hr

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 ...

Acadia Healthcare

Utilization Specialist

Conway, AR · 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 ...

Acadia Healthcare

Utilization Specialist

Allenwood, PA · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Pleasant and important work helping people in their journey towards recovery. Responsibilities ...

Acadia Healthcare

Utilization Specialist

Magee, MS · 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 ...

Acadia Healthcare

Utilization Specialist

Haverhill, MA · 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 ...

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 ...

Harboroaks

$65 - $90/hr

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 ...

New

Acadia Healthcare

Utilization Specialist

Riverdale, GA · 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 ...

Harboroaks

Utilization Specialist

Magee, MS · On-site

$48 - $72/hr

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 ...

New

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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 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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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.

RN UTILIZATION SPECIALIST - DENIALS & APPEALS

Southwest General

Middleburg Heights, OH • On-site

Full-time

Re-posted 3 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:Utilization Specialist Denials & Appeals will support the clinical staff, utilization specialists, denials management, and the Physician Advisors. This role will review patient medical records to ensure accurate documentation, proper level of care, and compliance with regulatory standards to prevent denials in the acute care setting.
  • MINIMUM QUALIFICATIONS
    • Education:
      • Bachelors degree in nursing (BSN) preferred

    • Required length and type of experience:
      • Minimum of three years of clinical nursing experience, with strong preference for experience in case management, utilization review, or CDI, in the acute care setting.
      • Knowledge of ICD-10 coding guidelines, Medicare/Medicaid regulations, MCG, Cerner (EMR), MS office tools, such as Word, Excel, PowerPoint.
      • Ability to analyze complex medical records and identify gaps in documentation.
      • Strong verbal and written communication skills to interact with physicians and insurance payers.
      • Ability to collaborate with diverse teams including nurses, physicians, and administrative staff.

    • Required licensure, certification or registry:
      • Current RN License by the Ohio State Board of Nursing.
      • Preferred certification(s): ACM/ACM-RN, CCM, CMAC, CPHQ.

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