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Weekend Utilization Review Jobs in Pennsylvania (NOW HIRING)

Penn Medicine

Utilization Review Nurse

West Chester, PA · On-site

The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and ...

IntePros

Utilization Review Nurse

Philadelphia, PA · On-site

This role is responsible for performing utilization management reviews to determine the medical necessity of requested healthcare services, ensuring members receive appropriate, evidence-based care ...

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How much do weekend utilization review jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for weekend utilization review in Pennsylvania is $42.38, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $48.65 per hour, depending on experience, location, and employer.

What is a weekend utilization review?

A Weekend Utilization Review job involves assessing patient care and medical services during weekends to ensure they meet medical necessity and insurance guidelines. Professionals in this role review clinical documentation, coordinate with healthcare providers, and determine appropriate levels of care for patients. They typically work for hospitals, insurance companies, or other healthcare organizations. Strong analytical skills, medical knowledge, and familiarity with regulatory requirements are essential for success in this role.

What does a weekend utilization review professional do?

Weekend Utilization Review professionals typically work independently, reviewing patient cases for medical necessity, appropriateness of care, and compliance with payer guidelines during non-standard business hours. You will analyze patient charts, interact with clinical staff, and document findings, often collaborating remotely with other care coordinators or medical teams. While much of the role is desk-based, quick decision-making and effective communication are essential due to faster-paced weekend workflows. This schedule can offer greater autonomy and flexibility, but may also require prioritizing tasks and managing multiple cases efficiently to ensure continuous patient care.

What are the key skills and qualifications needed to thrive in the weekend utilization review position?

Success as a Weekend Utilization Review professional requires a strong background in nursing or healthcare, critical thinking skills, and a thorough understanding of medical necessity criteria, such as InterQual or Milliman guidelines. Familiarity with electronic medical records (EMR) systems and utilization management software is highly beneficial, and RN or healthcare-related licensure is often required. Exceptional communication, attention to detail, and the ability to work independently on weekends are crucial soft skills. Mastering these areas allows efficient and accurate reviews of patient care, supporting optimal healthcare resource allocation outside of standard work hours.

What are the most commonly searched types of Utilization Review jobs in Pennsylvania?

The most popular types of Utilization Review jobs in Pennsylvania are:

What are popular job titles related to Weekend Utilization Review jobs in Pennsylvania?

For Weekend Utilization Review jobs in Pennsylvania, the most frequently searched job titles are:

What job categories do people searching Weekend Utilization Review jobs in Pennsylvania look for?

The top searched job categories for Weekend Utilization Review jobs in Pennsylvania are:

What cities in Pennsylvania are hiring for Weekend Utilization Review jobs?

Cities in Pennsylvania with the most Weekend Utilization Review job openings:

Weekend Utilization Review jobs near you
Infographic showing various Weekend Utilization Review job openings in Pennsylvania as of August 2026, with employment types broken down into 87% Full Time, and 13% Part Time. Highlights an 95% In-person, and 5% Remote job distribution, with an average salary of $88,158 per year, or $42.4 per hour.

Utilization Review Nurse

Pennsylvania Medicine

West Chester, PA • On-site

Other

Posted 18 days ago

Penn Medicine rating

7.6

Company rating: 7.6 out of 10

Based on 352 frontline employees who took The Breakroom Quiz

189th of 895 rated healthcare providers

Job description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Summary:

  • The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and appropriateness of the treatment plan. Uses critical thinking/leadership skills to ensure patients are at appropriate level of care, safely transitioned across the healthcare continuum, and third-party payor standards are met. Reports same to the Utilization Review Committee responsible for ensuring appropriate utilization review practices to decrease LOS/readmissions, prevent financial loss and lower financial risk. The Utilization Nurse will seek out and resolve discrepancies/delays in the care delivery process. Assures appropriate services are generated in a timely and cost-effective manner.
Responsibilities:
  • Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.
    Assesses patient progress through the expected in-house course, mobilizing resources of the patient care team to ensure patient outcomes are achieved as planned.
    Is the liaison between third party payors and actively participates in denial management activities.
    Works with physicians in documenting medical care to accurately and completely reflect intensity of service and severity of illness.
    Evaluates the appropriateness of continued stay by performing concurrent review and reviewing planned interventions with the physician. Makes appropriate recommendations for continued stay and/or modification of the care plan and course of treatment.
    Consults and advises members of the interdisciplinary team and ancillary staff to facilitate patients toward targeted outcomes.
    Collaborates appropriately with physician advisor to avoid denials.
    Serves as preceptor to new hires.
    Identifies trends in inappropriate utilization of resources, including, but not limited to, delays in diagnostic testing, medical surgical procedures and physician management.
    Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competence, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
    Communicates relevant clinical information including admission review, concurrent review and discharge planning needs, to third party payors to secure optimal reimbursement.
    Applies InterQual criteria to monitor appropriateness of admissions and continued stays and documents findings in the electronic health record.
    Follows 100% of assigned inpatient admissions
    Determines medical appropriateness of the patient's admission (severity of service)
    Monitors the plan of care and proactively identifies barriers to the plan (intensity of service)
    Intervenes to avoid delays in plan of care.
    Coordinates the flow of clinical information with third party payors to ensure appropriate reimbursement, proactively identifies potential denials in order to avoid non-appealable denials.
Credentials:
  • Registered Nurse - PA (Required)
  • Certified Case Manager
Education or Equivalent Experience:
  • Associate of Arts or Science (Required)
  • Major/Area of Study: Nursing/ASN 3+ years nursing experience
  • Bachelor of Arts or Science
  • Major/Area of Study: Nursing/BSN 3+ years nursing experience 1+ years utilization review
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

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