The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Mars, PA · On-site
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I
Mars, PA · On-site
Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
Two years of experience in Utilization Review. * Highly effective communication skills. * Ability to identify appropriate status and physician orders for the level of care the patient is or will be ...
UM Care Manager (RN)
Pittsburgh, PA · On-site
$34.49 - $56.83/hr
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
New
UM Care Manager (RN)
Pittsburgh, PA · On-site
$34.49 - $56.83/hr
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
New
UM Care Manager (RN)
Pittsburgh, PA · Remote
$34.49 - $56.83/hr
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
New
UM Care Manager (RN)
Pittsburgh, PA · Remote
$34.49 - $56.83/hr
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
New
UM Care Manager (RN)
Pittsburgh, PA · Remote
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
New
UM Care Manager (RN)
Pittsburgh, PA · Remote
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
New
UM Care Manager (RN)
Pittsburgh, PA · On-site
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
Posted today
UM Care Manager (RN)
Pittsburgh, PA · On-site
The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care. Interacts daily with facility clinicians ...
Posted today
Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance Expert)
Pittsburgh, PA · On-site +1
$40 - $42/hr
Comfort with technology and electronic medical records Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required. Why Join Us
Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance Expert)
Pittsburgh, PA · On-site +1
$40 - $42/hr
Comfort with technology and electronic medical records Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required. Why Join Us
Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance Expert)
Pittsburgh, PA · On-site
Comfort with technology and electronic medical records Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required. Why Join Us
Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance Expert)
Pittsburgh, PA · On-site
Comfort with technology and electronic medical records Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required. Why Join Us
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. Serves as an ...
Weekend Utilization Review information
See Pittsburgh, PA salary details
$20.77 - $24.97
2% of jobs
$24.97 - $29.17
9% of jobs
$32.05 is the 25th percentile. Wages below this are outliers.
$29.17 - $33.37
21% of jobs
The median wage is $36.77 / hr.
$33.37 - $37.57
23% of jobs
$37.57 - $41.77
13% of jobs
$45.04 is the 75th percentile. Wages above this are outliers.
$41.77 - $45.97
10% of jobs
$45.97 - $50.17
8% of jobs
$50.17 - $54.37
5% of jobs
$54.37 - $58.58
5% of jobs
$58.58 - $62.78
2% of jobs
$62.78 - $66.98
2% of jobs
$20
$41
$66
How much do weekend utilization review jobs pay per hour?
As of Aug 26, 2026, the average hourly pay for weekend utilization review in Pittsburgh, PA is $41.05, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $47.16 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 Pittsburgh, PA?
The most popular types of Utilization Review jobs in Pittsburgh, PA are:
What are popular job titles related to Weekend Utilization Review jobs in Pittsburgh, PA?
For Weekend Utilization Review jobs in Pittsburgh, PA, the most frequently searched job titles are:
- Remote Utilization Review Rn
- Utilization Review Rn
- Remote Utilization Review Nurse
- Remote Medical Record Review Nurse
- No Experience Utilization Review Nurse
- Part Time Utilization Review Nurse
- Home Based Utilization Review Nurse
- Full Time Remote Utilization Review Nurse
- Flex Schedule Remote Utilization Review Nurse
- Contract Utilization Review Nurse
What job categories do people searching Weekend Utilization Review jobs in Pittsburgh, PA look for?
The top searched job categories for Weekend Utilization Review jobs in Pittsburgh, PA are:
- Remote Navihealth Utilization Review
- Aetna Utilization Review Nurse
- Cigna Utilization Review Nurse
- Remote Aetna Utilization Review
- Insurance Utilization Review
- Remote Insurance Utilization Review
- Therapy Utilization Review
- Remote Aetna Utilization Review Nurse
- Medical Utilization Review Physician
- Remote Lpn Utilization Review
What cities near Pittsburgh, PA are hiring for Weekend Utilization Review jobs?
Cities near Pittsburgh, PA with the most Weekend Utilization Review job openings:
Utilization Management Rep I
Seven Fields, PA
Elevance Health •
Health Care and Social Assistance • 10K+ employees10,000+ employees
7.6
Based on 352 frontline employees who took The Breakroom Quiz
212th of 312 rated insurance
People enjoy working here
Good employer
Recommended by students
Paid breaks
Recommended by parents
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 5 days ago
Job description
Anticipated End Date:
2026-09-28Position Title:
Utilization Management Rep IJob Description:
Utilization Management Representative I
Shift: Monday-Friday
Location: Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.
How you will make an impact:
Managing incoming calls or incoming post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
Refers cases requiring clinical review to a Nurse reviewer.
Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
Responds to telephone and written inquiries from clients, providers and in-house departments.
Conducts clinical screening process.
Authorizes initial set of sessions to provider.
Checks benefits for facility based treatment.
Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment.
Strong verbal and written communication skills, both with virtual and in-person interactions.
Attentive to details, critical thinker, and a problem-solver.
Demonstrates empathy and persistence to resolve caller issues completely.
Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
Performs other duties as assigned.
Minimum Qualifications:
HS diploma or GED.
Minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Medical terminology training and experience in medical or insurance field preferred.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Job Level:
Non-Management Non-ExemptWorkshift:
1st Shift (United States of America)Job Family:
CUS > Care SupportPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.
About Elevance Health
Sourced by ZipRecruiter
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Indianapolis, IN, US
Year founded
2004
Website
What Elevance Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom