Top 789 Utilization Reviewer Jobs

Utilization Management Physician Reviewer
Oak Street Health —Illinois
- $174,070 - $374,920 a year
- Full-time
- Remote
- Medicine
- Mid-level
- US work authorization
- Health insurance
- Dental insurance
Utilization Management Physician Reviewer (Weekends)
Toney HealthCare Consulting, LLC —Remote
- $175 - $200 an hour
- Part-time
- Remote
- Medicine
- 3 years
- Senior level
- Health insurance
Quick Apply
3d
Utilization Reviewer (FT)
Rehabilitation Hospital of Indiana —Indianapolis, IN
- Full-time
- Hospital
- Mid-level
- 3 years
- Tuition reimbursement
- 401(k) matching
Quick Apply
12d
Utilization Review Specialist
We Level Up —Pompano Beach, FL
- $50,000 - $90,000 a year
- Full-time
- Remote
- 18 years or older
- CPR Certification
- HIPAA
Quick Apply
Endocrinologist - Independent Reviewer for Disability Appeals
Emperion —Remote
- $100 - $1,000 an hour
- Part-time
- Remote
- Mid-level
- 3 years
- Communication skills
Quick Apply
Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures —Remote
- $60,000 - $63,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Customer service
Quick Apply
Utilization Review Manager
Forest View Hospital —Grand Rapids, MI
- Full-time
- Management
- Psychiatry
- RN License
- Continuing education credits
- Health savings account
Quick Apply
Utilization Review Director
Aspen Grove Behavioral Hospital —Orem, UT
- Full-time
- Background check
- Master of Social Work
- Nursing
- Free parking
- Health savings account
Quick Apply
OASIS Workflow Coordinator Weekend - HomeCare
Hartford HealthCare at Home —Mansfield Center, CT
- Part-time
- Nursing
- RN License
- Writing skills
Quick Apply
FT Director of Utilization Review
River Point Behavioral —Jacksonville, FL
- Full-time
- Background check
- Nursing
- Addiction Medicine
- Health insurance
- Dental insurance
Quick Apply
BCBA Clinical Director
GBE Alliance —Hopkinsville, KY
- Full-time
- Background check
- 3 years
- Master's degree
- Paid holidays
- Dental insurance
Quick Apply
Oncology Nurse Navigator – Physician Aligned, BMG Oncology Elkhart, Full-time Days
Beacon Health System —Elkhart, IN
- Full-time
- Nursing
- RN License
- Mid-level
- 403(b) matching
- Health insurance
Quick Apply
Medical Director -- Part Time Contracted
Ventura County Health Care Plan —Oxnard, CA
- $156,000 - $195,000 a year
- Part-time
- Medicine
- BC/BE
- 3 years
Quick Apply
Structural Project Manager
JT Wimsatt Contracting Company, Inc —San Diego, CA
- $110,000 - $150,000 a year
- Full-time
- Microsoft Word
- Background check
- Microsoft Excel
- AD&D insurance
- Paid holidays
Quick Apply
Clinical Leader/Assistant Nurse Manager RN (ICU/CCU & Stepdown) - Nights
CentraState Healthcare System —Freehold, NJ
- $107,250 - $182,330 a year
- Full-time
- Acute care
- Nursing
- RN License
- 403(b) matching
- AD&D insurance
RN Clinical Reviewer
Greenlife Healthcare Staffing —Albany, NY
- $60 an hour
- Full-time
- Background check
- Nursing
- Microsoft Excel
- Paid sick time
Quick Apply
5d
Clinical Reviewer (BHJOB1435_35508)
Astyra Corporation —Indianapolis, IN
- $38 - $40 an hour
- Weekends as needed
- Remote
- Background check
- Nursing
- LVN
- Health insurance
- Dental insurance
Quick Apply
4d
Referral Management (Non-Nurse) Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $24.13 an hour
- Microsoft Excel
- Microsoft Outlook
- Mid-level
Care Plan Reviewer- OhioRISE
CVS Health —Ohio
- $60,522 - $129,615 a year
- Full-time
- LMFT
- Mid-level
- Outpatient experience
- Health insurance
- Dental insurance
11d
Therapist (AMFT, ASW, APCC) Santa Clarita - Mental Health and Substance Use
Santa Clarita Behavioral Health —Valencia, CA
- $33 - $40 an hour
- Part-time
- Background check
- Computer literacy
- Mid-level
- Health insurance
- Dental insurance
Quick Apply

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Utilization Management Physician Reviewer

Oak Street Health -
Illinois

Apply Now

Job Details

Full-time
$174,070 - $374,920 a year

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Inpatient experience
Utilization management
Resource utilization in healthcare
Medical License
Working with individuals from diverse cultural backgrounds
Care coordination

Full Job Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Company: Oak Street Health

Title: Full-Time Utilization Management Physician Reviewer

Location: Remote/ Treehouse

Role Description:

This full-time role is responsible for provisioning accurate and timely coverage determinations for inpatient and outpatient services by applying utilization management (UM) criteria, clinical judgment, and internal policies and procedures. Regardless of the final determination, the Physician Reviewer is responsible for ensuring medically appropriate care is recommended to the patient and their care team, which may require coordination with internal and external parties including, but not limited to: requesting providers, external UM and case management staff, internal transitional care managers, employed primary care providers, and regional medical leaders. We strive for clinical excellence and ensuring our patients receive the right care, in the right setting, at the right time.

Core Responsibilities:

Review service requests and document the rationale for the decision in easy to understand language per Oak Street Health policies and procedures and industry standards; types of requests include but not limited to: Acute, Post-Acute, and Pre-service (Expedited, Standard, and Retrospective)
Use evidence-based criteria and clinical reasoning to make UM determinations in concert with an enrolleeâs individual conditions and situation. OSH does not solely make authorization determinations based on criteria, but uses it as a tool to assist in decision making.
Work collaboratively with the Oak Street Health Transitional Care and PCP care teams to drive efficient and effective care delivery to patients
Maintain knowledge of current CMS and MCG evidence-based guidelines to enable UM decisions
Maintain compliance with legal, regulatory and accreditation requirements and payor partner policies
Participate in initiatives to achieve and improve UM imperatives; for example, participate in committees or work-groups to help advance UM efforts at Oak Street and promote a culture of continuous quality improvement
Assist in formal responses to health plan regarding UM process or specific determinations on an as-needed basis
Adhere to regulatory and accreditation requirements of payor partners (e.g., site visits from regulatory & accreditation agencies, responses to inquiries from regulatory and accreditation agencies and payor partners, etc.)
Participate in rounding and patient panel management discussions as required
Fulfill on-call requirement, should the need arise
Other duties, as required and assigned

What are we looking for?

At least one year experience providing Utilization Management services to a Medicare and/or Medicaid line of business
Excellent verbal and written communication skills
A current, clinical, unrestricted license to practice medicine in the United States. (NCQA Standard)
Graduate of an accredited medical school. M.D. or D.O. Degree is required. (NCQA Standard)
3-5 years of clinical practice in a primary care setting
Deep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy management
Strong record of continuing education activities (relevant to practice area and needed to maintain licensure)
Demonstrated understanding of culturally responsive care
Proven organizational and detail-orientation skills
US work authorization
Someone who embodies being Oaky

What does being Oaky look like?

Radiating positive energy
Assuming good intentions
Creating an unmatched patient experience
Driving clinical excellence
Taking ownership and delivering results
Being relentlessly determined

Why Oak Street Health?

Oak Street Health is on a mission to Rebuild healthcare as it should be, providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patientâs communities, and focused on the quality of care over volume of services. Weâre an organization on the move! With over 150 locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oaky values and passion for our mission.

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply.

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$174,070.00 - $374,920.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 06/26/2027

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Apply Now

Refine Your Search

Utilization Reviewer jobs

Utilization Management Physician Reviewer

Utilization Management Physician Reviewer (Weekends)

Utilization Reviewer (FT)

Utilization Review Specialist

Endocrinologist - Independent Reviewer for Disability Appeals

Remote Home Health RN – Medical Claims Reviewer

Utilization Review Manager

Utilization Review Director

OASIS Workflow Coordinator Weekend - HomeCare

FT Director of Utilization Review

BCBA Clinical Director

Oncology Nurse Navigator – Physician Aligned, BMG Oncology Elkhart, Full-time Days

Medical Director -- Part Time Contracted

Structural Project Manager

Clinical Leader/Assistant Nurse Manager RN (ICU/CCU & Stepdown) - Nights

RN Clinical Reviewer

Clinical Reviewer (BHJOB1435_35508)

Referral Management (Non-Nurse) Reviewer

Care Plan Reviewer- OhioRISE

Therapist (AMFT, ASW, APCC) Santa Clarita - Mental Health and Substance Use

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