Skill
Utilization Review
Healthcare and Medical
Utilization review is a specific component of utilization management in which clinical staff or insurers assess whether a proposed or delivered medical service is medically necessary and covered under a patient's health plan. It is performed by nurses, physicians, or specialized reviewers at health insurance companies and hospitals to prevent unnecessary care and control healthcare costs.
Utilization Review in the job market
Last checked October 28, 2026
- Open roles
- 6
- Employers
- 4
- Median pay
- —
- Disclose pay
- —
on Career App
hiring for it
not enough disclosed
of these roles
Open roles requiring Utilization Review (6)
Peds Case Management, PRN RN Discharge Planner
Vanderbilt University & Medical Center
Contract · Nashville, TN
This PRN position supports pediatric patients and families through discharge planning and case management, coordinating care across settings and removing barriers to appropriate follow-up. The role suits a registered nurse with at least two years of experience who can work a minimum of three shifts per six-week schedule and wants to partner with multidisciplinary teams on complex care coordination.
Listed on Vanderbilt University & Medical Center’s careers site · Apply there ↗
Medical Director – Otolaryngology – Evicore - Remote
Cigna
Full-time · United States Work at Home · $207,800 – $346,300 · Remote
A physician role conducting evidence-based medical necessity reviews for otolaryngology cases through telehealth peer-to-peer consultations. Suited for ENT specialists seeking remote work with clinical autonomy and structured support from a healthcare utilization review company.
Listed on Cigna’s careers site · Apply there ↗
BCBA Ph.D. or Psy.D Autism Specialist Psychologist-Clinical Reviewer (Florida Licensed)
Elevance Health
Full-time
A clinical psychologist with autism expertise will provide peer review and guidance for a behavioral health managed care organization, determining appropriate service levels and reviewing clinical decisions. The role suits licensed psychologists or behavior analysts with managed care experience who want to influence clinical programs at an insurer level.
Listed on Elevance Health’s careers site · Apply there ↗
Medical Director Orthopedic Surgery
Cohere Health
Full-time · United States · $240,000 – $260,000
Cohere Health seeks an orthopedic surgeon to review the medical necessity of orthopedic treatments and procedures for insurance prior authorizations and claims validation. The role suits experienced clinicians who want to impact millions of patients through AI-assisted review work in a fully remote setting.
Listed on Cohere Health’s careers site · Apply there ↗
Medical Director – Pediatric Otolaryngology – Evicore - Remote
Cigna
Full-time · United States Work at Home · $207,800 – $346,300 · Remote
A remote medical director role conducting evidence-based case reviews and peer consultations for pediatric otolaryngology cases at an insurance utilization review company. Suited for board-certified pediatric otolaryngologists seeking to apply clinical expertise in a structured, home-based environment with predictable scheduling.
Listed on Cigna’s careers site · Apply there ↗
Medical Director – Pediatric Pulmonology – Evicore - Remote
Cigna
Full-time · United States Work at Home · $207,800 – $346,300 · Remote
EviCore is seeking a physician with pediatric pulmonology expertise to conduct remote medical necessity reviews and peer-to-peer consultations with referring providers, supporting evidence-based care decisions. This role suits board-certified pediatric pulmonologists looking for flexible, structured remote work with no patient care obligations.
Listed on Cigna’s careers site · Apply there ↗
Roles that use Utilization Review
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