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Utilization 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

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 ...

Duke Health

Utilization Manager

Durham, NC · On-site

Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team ...

Samaritan Daytop Village

Utilization Manager

Queens, NY · On-site

$34.61 - $38.46/hr

Overview Utilization Manager Healthcare staff can work anywhere....The BEST work with US! $34.61-38.46 per hour A nationally recognized comprehensive Health and Human Services Agency, with over 60 ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH

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

Parma, OH

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

Berea, OH

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 ...

Acadia Healthcare

Utilization Specialist

Ocklawaha, FL · On-site

$20/hr

We are looking to for a Full Time Utilization Review Specialist to join our team. The UR specialist proactively monitors utilization of services for patients to optimize reimbursement for the ...

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 ...

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Utilization information

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How much do utilization jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for utilization in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a utilization specialist?

Utilization specialists are professionals who review and evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. They work closely with healthcare providers, insurance companies, and patients to ensure that care is delivered according to established guidelines and that resources are used effectively. Their goal is to help manage costs while ensuring patients receive the appropriate level of care.

What are some of the common challenges faced by utilization review specialists when assessing medical necessity of services?

Utilization Review Specialists often encounter the challenge of balancing patient advocacy with cost-effective care. They must stay updated on evolving insurance policies and clinical guidelines, which can be complex and change frequently. Additionally, coordinating with physicians and healthcare staff to obtain necessary documentation and clarifying treatment plans can be time-consuming. Strong communication skills and attention to detail are essential to ensure timely and accurate reviews, while also maintaining positive working relationships with clinical teams.

What are the key skills and qualifications needed to thrive as a utilization review specialist, and why are they important?

To thrive as a Utilization Review Specialist, you need a background in healthcare (often as an RN or LPN/LVN), strong analytical skills, and knowledge of insurance and medical necessity criteria. Familiarity with utilization management software, ICD-10/CPT coding, and regulatory guidelines like Medicare and Medicaid is typically required. Excellent attention to detail, critical thinking, and effective communication skills set top performers apart in this role. These abilities are crucial to accurately evaluating patient care needs, ensuring regulatory compliance, and optimizing resource use within healthcare organizations.

What is the difference between Utilization vs Resource Coordinator?

AspectUtilizationResource Coordinator
Primary FocusMeasuring and optimizing how staff time is usedManaging and assigning resources for projects
Required CredentialsOften no specific credentials, but industry experience helpsTypically requires organizational or project management skills
Work EnvironmentCorporate, healthcare, or consulting firmsProject teams, staffing agencies, or departments
Common UsageTracking staff utilization ratesAllocating resources to projects or tasks

Utilization focuses on measuring how effectively staff time is used, often to improve productivity. Resource Coordinator involves actively managing and assigning resources to ensure project needs are met. While related, utilization is more about analysis, and resource coordination is about execution and management.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of medical coding and insurance policies. Relevant certifications such as Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can enhance job prospects. Strong analytical skills and attention to detail are essential for reviewing medical records and determining appropriate service utilization.
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What are the most commonly searched types of Utilization jobs?

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What states have the most Utilization jobs?

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Utilization jobs near you
Infographic showing various Utilization job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 87% Full Time, 9% Part Time, and 2% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

UTILIZATION SPECIALIST

Southwest General

Hudson, OH • On-site

Other

Posted 19 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

552nd of 1,060 rated hospitals

Job description

  • 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 patient's plan of care. The Utilization Specialist's 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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