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Weekday Insurance Utilization Review Jobs (NOW HIRING)

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We ...

Genesis HealthCare

Works with insurance verification associates, billers, physicians, and patients to analyze and resolve payor authorization problems in order to assure timely reimbursement. Works with Utilization ...

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How much do weekday insurance utilization review jobs pay per hour?

As of Jun 1, 2026, the average hourly pay for weekday insurance utilization review 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 is the difference between Weekday Insurance Utilization Review vs Weekday Claims Processor?

AspectWeekday Insurance Utilization ReviewWeekday Claims Processor
Primary RoleAssessing medical necessity and appropriateness of servicesProcessing and reviewing insurance claims for payment
CredentialsOften requires healthcare or insurance certificationsTypically requires insurance or administrative experience
Work EnvironmentHealthcare settings, insurance companiesInsurance companies, healthcare offices
FocusMedical review and authorizationClaims data entry and verification

Weekday Insurance Utilization Review focuses on evaluating medical necessity, while Weekday Claims Processors handle the administrative processing of insurance claims. Both roles are essential in the insurance industry but serve different functions related to claims management and healthcare authorization.

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Weekday Insurance Utilization Review jobs near you
Utilization Review Physician

Utilization Review Physician

Dane Street, LLC

Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 18 days ago

Job description

Overview
We are seeking a high-performing Physician Reviewer to join our Group Health division. The role is responsible for delivering timely, defensible utilization review determinations across a high-volume, fast-paced environment. Reviews span multiple case types, including preauthorization, appeals, DRG clinical validation, benefit review, and experimental/investigational determinations.
Key Responsibilities
  • Perform utilization review for:
    • Preauthorization requests
    • Appeals (first and second level)
    • Independent external reviews
    • DRG validation and clinical review
    • Benefit and coverage determinations
    • Experimental/Investigational (E/I) review
  • Apply evidence-based criteria and guidelines, including:
    • InterQual
    • MCG
    • CMS guidelines (including 2-Midnight Rule)
    • LCD/NCD
    • Client-specific policies
  • Produce clear, concise, and defensible clinical rationales
  • Maintain high accuracy and consistency across determinations
  • Meet or exceed turnaround time (TAT) expectations, including urgent cases
  • Participate in peer-to-peer discussions as needed
  • Collaborate with QA and operational teams to ensure quality and compliance
  • Reviews may be conducted within internal systems or client-specific platforms, depending on assignment and client requirements

Performance Metrics
  • High daily review volume with strong accuracy
  • Consistent adherence to client-specific requirements
  • Ability to manage short-TAT and urgent cases efficiently
  • Clear, audit-ready documentation

Required Qualifications
  • MD or DO, board-certified in Internal Medicine, Family Medicine, or similar
  • Active, unrestricted medical license
  • Prior utilization review experience, preferably in a health plan or IRO environment
  • Familiarity with InterQual, MCG, and CMS guidelines
  • Strong clinical judgment and documentation skills
  • Ability to work independently in a high-throughput environment

Technical Skills
  • Proficiency with standard business tools (e.g., Google Workspace, Microsoft Office)
  • Comfortable working across multiple systems, including internal platforms and client-specific portals
  • Strong navigation and documentation skills within web-based applications
  • Ability to manage multiple systems/screens simultaneously in a high-throughput environment
  • Familiarity with Mac operating systems

Work Environment
  • Remote work from home
  • Full-time, Monday-Friday
  • Availability for occasional weekends and holiday coverage for urgent reviews

Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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