Reviews behavioral health cases to determine medical necessity and appropriateness of care ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Reviews behavioral health cases to determine medical necessity and appropriateness of care ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Care Review Nurse
Columbus, OH · On-site
Care Review Nurse Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing ...
Care Review Nurse
Columbus, OH · On-site
Care Review Nurse Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing ...
Care Review Nurse
Columbus, OH · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Care Review Nurse
Columbus, OH · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Utilization Review LVN/RN
Columbus, OH · On-site
Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories ... Conducts prior authorization reviews to determine financial responsibility Qualifications * 2 years ...
Utilization Review LVN/RN
Columbus, OH · On-site
Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories ... Conducts prior authorization reviews to determine financial responsibility Qualifications * 2 years ...
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... medical billing, behavioral health administration, or related healthcare setting preferred.
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... medical billing, behavioral health administration, or related healthcare setting preferred.
About the role The Transplant Nurse, Utilization Review is responsible for reviewing and processing medical services requests for members of Quantum Health's employer groups in an inpatient setting ...
New
About the role The Transplant Nurse, Utilization Review is responsible for reviewing and processing medical services requests for members of Quantum Health's employer groups in an inpatient setting ...
New
About the role The Transplant Nurse, Utilization Review is responsible for reviewing and processing medical services requests for members of Quantum Health's employer groups in an inpatient setting ...
New
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About the role The Transplant Nurse, Utilization Review is responsible for reviewing and processing medical services requests for members of Quantum Health's employer groups in an inpatient setting ...
New
UR Coordinator, Full Time
Columbus, OH · On-site
$24 - $32/hr
Experience in utilization review, case management, medical records, or healthcare billing strongly preferred * Strong understanding of insurance authorization processes (Medicare, Medicaid, and ...
UR Coordinator, Full Time
Columbus, OH · On-site
$24 - $32/hr
Experience in utilization review, case management, medical records, or healthcare billing strongly preferred * Strong understanding of insurance authorization processes (Medicare, Medicaid, and ...
Care Review Clinician
Columbus, OH · On-site
Care Review Clinician Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at ...
Care Review Clinician
Columbus, OH · On-site
Care Review Clinician Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at ...
Director Utilization Review directs the department's activities and resources to ensure alignment ... Competitive compensation and benefits packages including medical, dental, and vision with coverage ...
Director Utilization Review directs the department's activities and resources to ensure alignment ... Competitive compensation and benefits packages including medical, dental, and vision with coverage ...
Care Review Clinician
Columbus, OH · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Care Review Clinician
Columbus, OH · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
For billing and hospitalization utilization review purposes, the reviewer will identify and certify the acute hospitallength of stay authorized for each case. Initiate and maintain medical records ...
For billing and hospitalization utilization review purposes, the reviewer will identify and certify the acute hospitallength of stay authorized for each case. Initiate and maintain medical records ...
Care Review Processor I
Columbus, OH · On-site
Medical background, prior authorization experience. A minimum of 1-2 years' experience. Knowledge ... or utilization review for other healthcare services. Checks eligibility and verifies benefits ...
Care Review Processor I
Columbus, OH · On-site
Medical background, prior authorization experience. A minimum of 1-2 years' experience. Knowledge ... or utilization review for other healthcare services. Checks eligibility and verifies benefits ...
Care Review Processor
Columbus, OH · On-site
A minimum 1 year of Managed care experience, Medical billing, within a healthcare background ... utilization review for other healthcare services * Checks eligibility and verifies benefits ...
Care Review Processor
Columbus, OH · On-site
A minimum 1 year of Managed care experience, Medical billing, within a healthcare background ... utilization review for other healthcare services * Checks eligibility and verifies benefits ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Family Practice Physician Outpatient Only Practitioner - Physicians Only Apply - Perm
Columbus, OH · On-site
$215K - $344K/yr
Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective ...
Family Practice Physician Outpatient Only Practitioner - Physicians Only Apply - Perm
Columbus, OH · On-site
$215K - $344K/yr
Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective ...
Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. * Conducts research into new or controversial medical procedures ...
Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. * Conducts research into new or controversial medical procedures ...
Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. * Conducts research into new or controversial medical procedures ...
Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. * Conducts research into new or controversial medical procedures ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. * Conducts research into new or controversial medical procedures ...
Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. * Conducts research into new or controversial medical procedures ...
Medical Utilization Review information
See salary details
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
How much do medical utilization review jobs pay per hour?
As of Aug 27, 2026, the average hourly pay for medical utilization review 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 are popular job titles related to Medical Utilization Review jobs?
For Medical Utilization Review jobs, the most frequently searched job titles are:
What job categories do people searching Medical Utilization Review jobs look for?
The top searched job categories for Medical Utilization Review jobs are:
What cities are hiring for Medical Utilization Review jobs?
Cities with the most Medical Utilization Review job openings:
What states have the most Medical Utilization Review jobs?
States with the most job openings for Medical Utilization Review jobs include:
Full-time
Re-posted 6 days ago
Nationwide Children's Hospital rating
6.9
Based on 131 frontline employees who took The Breakroom Quiz
551st of 1,064 rated hospitals
Job description
Overview:
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Job Description:
Essential Functions:
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
Experience:
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Job Description:
Essential Functions:
- Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines.
- Communicates with healthcare teams and third-party payors to ensure the delivery of quality care and optimum payment.
- Assists with retrospective reviews and denial management to maintain appropriate and cost-effective patient care.
- Documents all case reviews and maintains accurate records of all clinical activities and coverage information.
- Provides education and support regarding utilization review and management activities and processes.
- Analyzes clinical data to identify trends and patterns that may impact patient care. Participates in quality improvement initiatives to enhance the overall delivery of behavioral health services.
- Facilitates reimbursement by communicating with payers, other staff, patients, and families concerning status of funding and required actions.
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
- Excellent written and verbal communication and interpersonal skills.
- Excellent customer service and organizational skills.
- Working knowledge of CMS and other review agency standards.
- Proficient with software applications including CM, payer web applications, MITS, and others.
Experience:
- Three years of behavioral health experience, required.
- One year of experience in pediatric care or services, required.
- Utilization review or utilization management experience, preferred.
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
What Nationwide Children's Hospital employees say
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Benefits
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Get the full story on Breakroom
About Nationwide Children's Hospital
Sourced by ZipRecruiter
Nationwide Children's Hospital, established in 1894, is a leading pediatric healthcare system based in Columbus, Ohio, United States. They serve as a primary pediatric network, providing wellness, preventive, diagnostic, treatment, and rehabilitative care for infants, children, adolescents, and adults with congenital disease. Being the third-largest pediatric hospital in the nation, Nationwide Children's Hospital prides itself on its relentless commitment to children and their families, driven by their core values of respect, integrity, determination, empathy, and solidarity. The institution's comprehensive mission is to enhance the health of children by providing high-quality, family-centered care, conducting groundbreaking research, advocating for pediatric health, and training top healthcare professionals.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Columbus, OH, US
Year founded
1892