Utilization Review Specialist Jobs
Utilization Review Specialist jobs are open across health insurance, managed care, hospital systems, and third-party administrators, from entry-level reviewer to senior and lead, with specializations in clinical, behavioral health, and workers' compensation review. Scan the live roles below and apply to whichever ones fit.
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SUMMARY:
The Authorization Nurse will oversee the processing of assigned authorizations for participant care, supplies, and other related needs. This will include but not be limited to primary responsibility for Emergency Room and Hospital Admission authorizations as well as oversight of accurate completion of all other types in conjunction with clinical and supportive staff.
SPECIFIC DUTIES AND FUNCTIONS:
- Enter authorizations for participants seen in Emergency Departments and/or Admitted to the Hospital, including Observation stays; complete authorization to include all required information (i.e. discharge date, diagnosis, discharge location).
- Coordinate authorization information for all participant care needs with interdisciplinary team (IDT) members ensuring completeness of all required information.
- In tandem with Authorization Coordinator, monitor all participant authorizations in EMR for accuracy and correct information.
- Assess need and provide education to IDT staff regarding authorization processing and management to improve compliance where required.
- Recommend workflow modifications/changes to improve PACE Southeast MI authorization management in terms of both efficiency and quality.
- Audit EMR (currently TruChart) for authorization status, notifying individuals and leadership of any trends or issues relating to timeliness, error rates, or similar quality issues.
- Assign specific tasks to support audit needs and action plans to Authorization Coordinator.
- Present audit findings to key Leadership Team members on a regular basis plus as requested, participating as a member of the PACE Southeast MI Quality Improvement Team.
- Other duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
- Registered Nurse in State of MI with unencumbered license, BSN preferred;
- Minimum 2 years’ experience in a managed care environment, preferably in a utilization related role;
- Must have one year of experience with a frail, elderly population
WORK ENVIRONMENT:
- Professional office environment
- Occasional interaction with participants with risk of exposure to communicable diseases
SUMMARY:
The Authorization Nurse will oversee the processing of assigned authorizations for participant care, supplies, and other related needs. This will include but not be limited to primary responsibility for Emergency Room and Hospital Admission authorizations as well as oversight of accurate completion of all other types in conjunction with clinical and supportive staff.
SPECIFIC DUTIES AND FUNCTIONS:
- Enter authorizations for participants seen in Emergency Departments and/or Admitted to the Hospital, including Observation stays; complete authorization to include all required information (i.e. discharge date, diagnosis, discharge location).
- Coordinate authorization information for all participant care needs with interdisciplinary team (IDT) members ensuring completeness of all required information.
- In tandem with Authorization Coordinator, monitor all participant authorizations in EMR for accuracy and correct information.
- Assess need and provide education to IDT staff regarding authorization processing and management to improve compliance where required.
- Recommend workflow modifications/changes to improve PACE Southeast MI authorization management in terms of both efficiency and quality.
- Audit EMR (currently TruChart) for authorization status, notifying individuals and leadership of any trends or issues relating to timeliness, error rates, or similar quality issues.
- Assign specific tasks to support audit needs and action plans to Authorization Coordinator.
- Present audit findings to key Leadership Team members on a regular basis plus as requested, participating as a member of the PACE Southeast MI Quality Improvement Team.
- Other duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
- Registered Nurse in State of MI with unencumbered license, BSN preferred;
- Minimum 2 years’ experience in a managed care environment, preferably in a utilization related role;
- Must have one year of experience with a frail, elderly population
WORK ENVIRONMENT:
- Professional office environment
- Occasional interaction with participants with risk of exposure to communicable diseases
Utilization Review Specialist Jobs by Experience Level
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Find JobsUtilization Review Specialist Job Market
Who's Hiring
Top Industries Hiring
- Healthcare & Medical Services
- Insurance
- Education
- Human Resources
- Science & Research
What Employers Look For
The qualifications that appear most often in utilization review specialist jobs.
- Active RN, LPN, or other clinical licensure in the state of hire
- Demonstrated experience applying InterQual or Milliman clinical criteria
- Knowledge of medical necessity guidelines and insurance authorization processes
- Minimum two to three years of acute care, managed care, or case management experience
- Proficiency with electronic health records and utilization management software platforms
- Familiarity with CMS, URAC, or NCQA compliance and documentation standards
Tips for Your Utilization Review Specialist Job Search
Tailor your resume to clinical criteria
Highlight your hands-on experience applying InterQual or Milliman criteria, not just that you know them. Hiring managers want to see the specific care settings, payer types, and case volumes you've worked with, so name them directly.
List your active clinical licensure prominently
RN, LPN, LCSW, or other clinical credentials belong in a dedicated section at the top of your resume, not buried in a summary paragraph. Many applicant tracking systems filter on licensure before a human ever sees your file.
Apply early to roles that fit
Migrate Mate lists utilization review specialist openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Filter openings by payer versus provider side
Payer-side UR roles focus on authorizations and denials from the insurance perspective, while provider-side roles manage internal case management workflows. Knowing which side you're targeting sharpens your cover letter and prevents awkward mismatches at the phone screen.
Prepare for scenario-based interview questions
Expect interviewers to walk you through a real-world denial scenario and ask how you'd document the clinical rationale or handle a peer-to-peer review request. Rehearse a concise example that shows your reasoning process and how you stayed compliant with regulatory timelines.
Negotiate remote work terms before accepting
Many UR roles are posted as remote but require specific state licensure for the states you'll be reviewing. Confirm which states are covered before the offer stage, and ask whether the employer will support multi-state licensure costs if you don't already hold them.
Utilization Review Specialist Jobs: Frequently Asked Questions
Which companies are hiring the most utilization review specialists?
The most active employers for utilization review specialists right now are UT Southwestern Medical Center, Providence, and MedStar Health, and the most openings are in California, Texas, and Ohio, based on current listings on Migrate Mate as of November 2026. Health insurance carriers and large managed care organizations consistently post the highest volume of these roles.
How many utilization review specialist jobs are remote?
About 73% of utilization review specialist openings are fully remote or hybrid as of November 2026, making this one of the more remote-accessible clinical roles available. Prospective review and concurrent review positions tend to be the most remote-friendly, while on-site requirements are more common for roles embedded in hospital case management departments.
How do you become a utilization review specialist?
Start by earning an active clinical license, most commonly as a registered nurse, though social workers, physical therapists, and other clinicians also qualify for many positions. Build experience in a direct care setting such as acute care, case management, or a managed care environment. Then develop working knowledge of clinical criteria tools like InterQual or Milliman, since most UR roles require you to apply these on day one.
Can you get hired as a utilization review specialist with little experience?
Some entry-level UR roles are open to candidates with strong bedside nursing or case management backgrounds even without prior utilization review experience, because clinical judgment transfers directly. Focus your application on acute care settings where you've made real-time care decisions, documented medical necessity, or coordinated with payers. Highlighting any exposure to insurance authorizations or discharge planning gives you a concrete edge over candidates without that context.
What does the utilization review specialist interview process look like?
Most processes start with a recruiter phone screen to confirm licensure, clinical background, and remote setup if applicable. A hiring manager interview follows, usually focused on how you apply clinical criteria, handle physician pushback during peer-to-peer reviews, and document denial rationales. Some employers add a written scenario exercise where you review a mock case and explain your determination, so be ready to walk through your clinical reasoning out loud.
Where can I find and apply to utilization review specialist jobs?
You can find and apply to utilization review specialist jobs on Migrate Mate, which lists current openings from across the United States. Search the roles available, find the ones that match your licensure, experience, and preferred work arrangement, and apply directly to each listing that fits.
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