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Utilization Review Tech II
Company : Prime Healthcare Services
Location : Philadelphia, PA, 19128
Job Type : Full Time
Date Posted : 10 January 2026
Overview
Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Roxborough Memorial Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.
Roxborough Memorial Hospital is a 131-bed community hospital. The hospital has been serving the medical and health care needs of the Roxborough, Manayunk, East Falls and northwest section of Philadelphia communities for more than a century, having first opened its doors in 1890. Roxborough Memorial Hospitals School of Nursing has been educating nurses since 1898. The hospital is accredited by the Joint Commission on the Accreditation of Healthcare Organizations, the nation's oldest and largest hospital accreditation agency.
Responsibilities
The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. The Utilization review tech will further support the department needs for Release of Information, discharge coordination or other duties as assigned.
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Qualifications
EDUCATION, EXPERIENCE, TRAINING
1. High School Diploma or equivalent required.
2. Associates degree or higher preferred.
3. Two years of relevant experience required
4. Accurate alphabetic, numeric, and/or terminal-digit filing skills.
5. Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.
6. Knowledge of terminal digit filing and medical terminology; preferred.
7. Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
8. Completion of a medical terminology course; preferred.
9. Background in business and office training; preferred.
Employment Status
Full TimeShift
DaysEqual Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
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Frequently asked questions
In Philadelphia, a Utilization Review Tech II navigates between managing insurance provider communications and ensuring adherence to local and federal healthcare regulations. This balance is crucial for optimizing patient care approvals while maintaining regulatory standards within community hospitals like Roxborough Memorial.
Beyond a high school diploma, advancing to a Utilization Review Tech II typically requires two years of relevant experience, proficiency in medical terminology, and skills in data entry with tools like Excel. These competencies enable more autonomous handling of complex appeals and audit tracking.
Unlike entry-level reviewers, a Utilization Review Tech II often spearheads denial management, coordinates multi-party communications, and tracks government audits such as RAC and MAC. This role demands meticulous documentation and close collaboration with case managers and business offices.
Prime Healthcare Services emphasizes a community-focused approach with a century-long legacy in Philadelphia. Their Utilization Review Tech II role integrates adherence to rigorous accreditation standards while fostering compassion and quality, creating a unique workplace culture.
The hospital’s longstanding service since 1890 shapes the role by embedding a commitment to community health and quality assurance. This heritage reinforces the necessity for precise utilization reviews aligned with both traditional values and modern healthcare compliance.
Market data indicates that Utilization Review Tech II professionals in Philadelphia typically earn between $50,000 and $65,000 annually, factoring in healthcare sector demand and cost of living. This range reflects the specialized nature of utilization management expertise.
While not always mandatory, certifications such as Certified Professional in Utilization Review (CPUR) or relevant medical terminology courses can enhance credibility. Philadelphia employers often value familiarity with state and federal health regulations alongside practical experience.
Philadelphia’s healthcare sector shows steady demand for utilization review professionals, but competition heightens for positions at reputable institutions like Prime Healthcare. Candidates with solid experience and proficiency in audit processes generally have an advantage.
Emphasizing efficient data management, strong communication with insurance providers, and mastery of audit tracking systems will resonate well. Additionally, showcasing knowledge of medical terminology and compliance with healthcare regulations strengthens candidacy.
Yes, the role offers opportunities to expand into advanced utilization management, case coordination, or administrative healthcare leadership. Prime Healthcare’s emphasis on professional development supports career advancement within their network and the broader healthcare industry.