Top 681 Utilization Reviewer Jobs

Utilization Management Clinical Reviewer
CuraFi —San Francisco, CA
- $140,000 - $160,000 a year
- Full-time
- Hybrid work
- RN License
- Senior level
- Communication skills
- Health insurance
- Dental insurance
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5d
Utilization Management Clinician I
Community Health Plan of Washington —Seattle, WA
- $35.92 - $55.67 an hour
- Full-time
- Mid-level
- Analysis skills
- Critical & Intensive Care
- Paid jury duty
- Health savings account
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Utilization Management Physician Reviewer (Weekends)
Toney HealthCare Consulting, LLC —Remote
- $175 - $200 an hour
- Part-time
- Remote
- Medicine
- 3 years
- Senior level
- Health insurance
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4d
Utilization Reviewer (FT)
Rehabilitation Hospital of Indiana —Indianapolis, IN
- Full-time
- Hospital
- Mid-level
- 3 years
- Tuition reimbursement
- 401(k) matching
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13d
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
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Endocrinologist - Independent Reviewer for Disability Appeals
Emperion —Remote
- $100 - $1,000 an hour
- Part-time
- Remote
- Mid-level
- 3 years
- Communication skills
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Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures —Remote
- $60,000 - $63,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Customer service
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Physician Reviewer - Physical Medicine and Rehabilitation (Utilization Review)
Dane Street, LLC —New York, NY
- Remote
- Physical & Rehabilitation Medicine
- Mid-level
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Utilization Reviewer
Element Medical Billing —Port Saint Lucie, FL
- $45,000 - $60,000 a year
- Full-time
- Anatomy knowledge
- HIPAA
- Mid-level
- Health insurance
- Dental insurance
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Initial Clinical Reviewer
Enlyte —Remote
- $59,000 - $73,000 a year
- Full-time
- Remote
- Clinic experience
- Mid-level
- Analysis skills
- Health savings account
- AD&D insurance
6d
Utilization Management Physician Reviewer (TX Licensed)
Clearlink Partners —Remote
- $100 - $150 an hour
- Monday to Friday
- Medicine
- 7 years
- Writing skills
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OASIS Workflow Coordinator Weekend - HomeCare
Hartford HealthCare at Home —Mansfield Center, CT
- Part-time
- Nursing
- RN License
- Writing skills
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
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
BCBA Clinical Director
GBE Alliance —Hopkinsville, KY
- Full-time
- Background check
- 3 years
- Master's degree
- Paid holidays
- Dental insurance
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 Management RN – CALIFORNIA LICENSE REQUIRED
TotalMed Medfi —Remote
- $46 - $52 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Commercial
- Health insurance
- Dental insurance
Quick Apply
3d
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
RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Inpatient
Quick Apply
10d
Licensed Physician Reviewer-GI (remote)
ChenMed —Miami, FL
- $204,761 - $292,515 a year
- Full-time
- Remote
- Medicine
- Microsoft Excel
- Microsoft Outlook
- Opportunities for advancement

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Utilization Management Clinical Reviewer

CuraFi
San Francisco, CA

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Job Details

Full-time
$140,000 - $160,000 a year
5 days ago

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Life insurance

Qualifications

Strategic management
Teamwork
RN License
Attention to detail
Documentation review

Full Job Description

CuraFi is a fast-paced healthcare technology startup helping providers, ACOs, RBOs, and payers improve utilization management, prior authorization workflows, specialty drug management, referral management, care coordination, and provider engagement.

We are looking for an experienced RN with strong critical thinking skills, with the ability to analyze clinical and operational decisions through both a business value and clinical integrity lens. This is a hybrid leadership and hands-on operations role. Approximately 50% of the role will involve direct review and processing of clinical cases, while the remaining time will focus on team oversight, workflow improvement, provider engagement, guideline development, and product collaboration.

Key Responsibilities

Lead and manage a clinical operations team of pharmacists, RNs, and other clinical staff.
Spend approximately 50% of time directly performing hands-on clinical operations work, including reviewing and processing medical records, claims, and lab/imaging results to determine diagnostic accuracy, UM cases, prior authorization requests, case reviews, provider outreach tasks, documentation checks, and guideline-based determinations.
Critically analyze clinical, operational, and business tradeoffs to drive measurable value for CuraFi’s customers while maintaining clinical integrity, compliance, and patient-centered decision-making.
Operational oversight over utilization management workflows, prior authorization reviews, case reviews, provider outreach, and network development activities.
Support development and maintenance of clinical guidelines, utilization criteria, specialty drug policies, and clinical review protocols.
Set up strategic communications and partnerships with providers, medical groups, payers, and internal teams to improve workflows, reduce administrative burden, and resolve case-level issues.
Support network development efforts, including provider engagement, specialist routing, referral workflows, and performance improvement initiatives.
Identify workflow gaps, operational bottlenecks, quality issues, and opportunities for automation or product improvement.
Project manage and set up internal SOPs and obtain/keep current certifications such as NCQA, URAC accreditation
Work closely with product, engineering, and leadership teams to translate clinical and operational needs into product requirements.
Train, coach, and support clinical team members in a fast-changing startup environment.
Track operational metrics, quality outcomes, SLA performance, provider response rates, and case review trends.
Support audits, compliance reviews, documentation standards, and process improvement initiatives.

Ideal Candidate

Active RN license.
Experience in utilization management, prior authorization, case management, managed care, payer operations, ACO/RBO operations, or provider group operations.
Strong understanding of Medicare, CMS requirements, specialty drugs, referrals, provider workflows, and clinical documentation.
Experience managing or mentoring clinical teams.
Comfortable reviewing complex clinical cases and applying medical policy or evidence-based criteria.
Strong communication skills with providers, clinical staff, payers, and internal product/engineering teams.
Able to move between strategy and execution: building processes while also jumping into day-to-day operational work.
Highly organized, detail-oriented, and comfortable working in a fast-paced startup environment.
Comfortable with technology, workflow tools, spreadsheets, clinical platforms, and AI-enabled clinical operations.

Preferred Qualifications

Experience working with pharmacists or multidisciplinary clinical review teams.
Experience with Medicare Advantage, Part B drugs, Part D drugs, specialty pharmacy, delegated UM, or provider network management.
Experience developing clinical guidelines, medical policies, or utilization criteria.
Prior startup, health tech, payer, MSO, IPA, ACO, or value-based care experience.
Familiarity with NCQA, CMS ODAG/CDAG, HIPAA, audit readiness, and clinical quality processes.

Why Join CuraFi

This is a high-impact role for someone who wants to help build the clinical operating model for a growing healthcare startup. You will shape workflows, lead clinical teams, support provider-facing operations, influence product development, and directly improve how providers and payers manage complex care.

Pay: $140,000.00 - $160,000.00 per year

Benefits:

401(k)
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Work Location: Hybrid remote in San Francisco, CA 94107

Quick Apply

Refine Your Search

Utilization Reviewer jobs

Utilization Management Clinical Reviewer

Utilization Management Clinician I

Utilization Management Physician Reviewer (Weekends)

Utilization Reviewer (FT)

Utilization Review Specialist

Endocrinologist - Independent Reviewer for Disability Appeals

Remote Home Health RN – Medical Claims Reviewer

Physician Reviewer - Physical Medicine and Rehabilitation (Utilization Review)

Utilization Reviewer

Initial Clinical Reviewer

Utilization Management Physician Reviewer (TX Licensed)

OASIS Workflow Coordinator Weekend - HomeCare

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

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

BCBA Clinical Director

Utilization Review Manager

Utilization Management RN – CALIFORNIA LICENSE REQUIRED

Medical Director -- Part Time Contracted

RN Team Lead Utilization Review

Licensed Physician Reviewer-GI (remote)

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