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 ...
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 ...
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 ...
SUMMARY The Utilization Management Specialist is responsible for coordinating and managing all ... Monitors and reviews MCO portals to track authorization status, pending requests, approvals ...
Quick apply
SUMMARY The Utilization Management Specialist is responsible for coordinating and managing all ... Monitors and reviews MCO portals to track authorization status, pending requests, approvals ...
Utilization Review LVN/RN
Columbus, OH · On-site
Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...
Utilization Review LVN/RN
Columbus, OH · On-site
Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...
Director Utilization Review directs the department's activities and resources to ensure alignment with the mission, values, and objectives of the department and organization What you will do:
Director Utilization Review directs the department's activities and resources to ensure alignment with the mission, values, and objectives of the department and organization What you will do:
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 ...
Posted today
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 ...
Posted today
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 ...
Posted today
Quick apply
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 ...
Posted today
UR Coordinator, Full Time
Columbus, OH · On-site
$24 - $32/hr
About the Role RiverVista is seeking a detail-oriented and knowledgeable Utilization Review (UR) Coordinator to support clinical documentation, insurance authorization processes, and regulatory ...
UR Coordinator, Full Time
Columbus, OH · On-site
$24 - $32/hr
About the Role RiverVista is seeking a detail-oriented and knowledgeable Utilization Review (UR) Coordinator to support clinical documentation, insurance authorization processes, and regulatory ...
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 ...
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 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 ...
Physician Reviewer-Radiology (Part Time)
Columbus, OH · On-site
$95 - $100/hr
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a ... Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ...
Physician Reviewer-Radiology (Part Time)
Columbus, OH · On-site
$95 - $100/hr
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a ... Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ...
Physician Reviewer-Radiology (Full-Time)
Columbus, OH · On-site
$95 - $96/hr
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a ... Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ...
Physician Reviewer-Radiology (Full-Time)
Columbus, OH · On-site
$95 - $96/hr
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a ... Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ...
Rheumatologist-Physician Reviewer-Radiology (Full-Time)
Columbus, OH · On-site
$95 - $109/hr
Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...
Rheumatologist-Physician Reviewer-Radiology (Full-Time)
Columbus, OH · On-site
$95 - $109/hr
Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...
Endocrinology-Physician Reviewer-Radiology (Full-Time)
Columbus, OH · On-site
$95 - $109/hr
Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...
Endocrinology-Physician Reviewer-Radiology (Full-Time)
Columbus, OH · On-site
$95 - $109/hr
Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...
Otolaryngologist-Physician Reviewer-Radiology (Full-Time)
Columbus, OH · On-site
$95 - $109/hr
Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...
Otolaryngologist-Physician Reviewer-Radiology (Full-Time)
Columbus, OH · On-site
$95 - $109/hr
Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...
Family Medicine-Physician Reviewer-Radiology (Full-Time or Part-time)
Columbus, OH · On-site
$95 - $96/hr
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a ... Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ...
Family Medicine-Physician Reviewer-Radiology (Full-Time or Part-time)
Columbus, OH · On-site
$95 - $96/hr
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a ... Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable ...
Care Review Processor I
Columbus, OH · On-site
... utilization review for other healthcare services. Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the ...
Care Review Processor I
Columbus, OH · On-site
... utilization review for other healthcare services. Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the ...
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 ...
Utilization Reviewer information
See salary details
$31K - $32.2K
3% of jobs
$32.2K - $33.4K
14% of jobs
$34.2K is the 25th percentile. Wages below this are outliers.
$33.4K - $34.5K
12% of jobs
$34.5K - $35.7K
12% of jobs
$35.7K - $36.9K
9% of jobs
The median wage is $37K / yr.
$36.9K - $38.1K
5% of jobs
$38.1K - $39.3K
0% of jobs
$39.3K - $40.5K
3% of jobs
$40.5K - $41.6K
9% of jobs
$42.1K is the 75th percentile. Wages above this are outliers.
$41.6K - $42.8K
20% of jobs
$42.8K - $44K
13% of jobs
$31K
$38K
$44K
How much do utilization reviewer jobs pay per year?
As of Aug 26, 2026, the average yearly pay for utilization reviewer in the United States is $37,992.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,000.00 and $42,000.00 per year, depending on experience, location, and employer.
More about Utilization Reviewer jobs
What are popular job titles related to Utilization Reviewer jobs?
For Utilization Reviewer jobs, the most frequently searched job titles are:
- Remote Therapy Clinical Reviewer
- Remote Utilization Review Physical Therapist
- Therapist Utilization Review Remote
- Full Time Remote Behavioral Health Utilization Review
- Remote Utilization Review Social Worker
- Part Time Utilization Review Therapist
- Remote Utilization Review Nurse
- Clinical Insurance Reviewer
- Urgently Hiring Remote Clinical Reviewer
- Evening Optum Health Utilization Review
What job categories do people searching Utilization Reviewer jobs look for?
The top searched job categories for Utilization Reviewer jobs are:
- Position Aetna Utilization Review
- Utilization Management Reviewer
- Flexible Schedule Remote Physical Therapy Utilization Review
- Full Time Cigna Utilization Review
- Cigna Utilization Review Remote
- Therapy Utilization Review
- Insurance Utilization Reviewer
- Part Time Utilization Review
- Remote Dental Utilization Review
- Remote Physical Therapy Utilization Review
What cities are hiring for Utilization Reviewer jobs?
Cities with the most Utilization Reviewer job openings:
What states have the most Utilization Reviewer jobs?
States with the most job openings for Utilization Reviewer jobs include:
Full-time
Re-posted 5 days ago
Nationwide Children's Hospital rating
6.9
Based on 131 frontline employees who took The Breakroom Quiz
547th 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
Hours and flexibility
Workplace
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