ZipRecruiter

Log In

1

Manager Anthem Utilization Review Nurse Jobs (NOW HIRING)

Sentara Health Plans

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

New

Sentara Health Plans

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

New

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

$55 - $90/hr

Experience in utilization review or case management is highly beneficial, particularly within ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

Acrisure, LLC

$55 - $90/hr

Experience in utilization review or case management is highly beneficial, particularly within ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

New

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

We use population health management tools to employ a holistic approach to caring for the highest ... The Utilization Review Nurse ensures appropriate utilization of health services by performing ...

next page

Showing results 1-20

All JobsHealthcare JobsNursing JobsNurse Case Manager JobsManager Anthem Utilization Review Nurse Jobs

Manager Anthem Utilization Review Nurse information

See salary details

$21

$42

$68

How much do manager anthem utilization review nurse jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for manager anthem utilization review nurse in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a Manager Anthem Utilization Review nurse?

A Manager Anthem Utilization Review Nurse is a registered nurse who oversees the utilization review process at Anthem, a major health insurance provider. This role involves supervising a team of nurses who assess the medical necessity and appropriateness of healthcare services for members. The manager ensures compliance with company policies, federal and state regulations, and industry standards. Additionally, they collaborate with healthcare providers, manage workflow, and contribute to quality improvement initiatives to optimize patient outcomes and cost efficiency.

What are the key skills and qualifications needed to thrive as a Manager Anthem Utilization Review nurse?

To thrive as a Manager Anthem Utilization Review Nurse, you need a valid RN license, strong clinical experience, and expertise in utilization review processes. Familiarity with utilization management software, case management systems, and knowledge of regulatory requirements such as NCQA and CMS guidelines are typically required, along with certifications like CCM or URAC accreditation. Leadership, critical thinking, and effective communication are essential soft skills for managing teams and collaborating with internal and external stakeholders. These skills ensure efficient review processes, regulatory compliance, and the delivery of high-quality, cost-effective care.

What are some common challenges faced by a Manager Anthem Utilization Review nurse, and how can they be addressed?

One common challenge for a Manager Anthem Utilization Review Nurse is balancing the need for timely, effective decision-making with the complexities of evolving healthcare regulations and payer requirements. Managing a team of review nurses also requires strong leadership to ensure consistency in clinical determinations and to support staff development. Building effective communication channels with providers and internal teams can help resolve disputes and streamline workflow. Staying updated on policy changes and offering ongoing training can ensure compliance and maintain high-quality utilization review standards.

What is the difference between Manager Anthem Utilization Review Nurse vs Anthem Utilization Review Nurse?

AspectManager Anthem Utilization Review NurseAnthem Utilization Review Nurse
CertificationsRN license, possibly management certificationsRN license, utilization review certifications
Work EnvironmentSupervisory role, team managementPerforming reviews, case assessments
Employer & IndustryHealth insurance companies, healthcare industryHealth insurance companies, healthcare industry

The Manager Anthem Utilization Review Nurse oversees review teams and manages processes, while the Anthem Utilization Review Nurse focuses on conducting individual case reviews. Both roles require RN licensure and utilization review certifications, but the manager position involves leadership responsibilities. Understanding these differences helps job seekers identify the right role based on experience and career goals.

What cities are hiring for Manager Anthem Utilization Review Nurse jobs?

Cities with the most Manager Anthem Utilization Review Nurse job openings:

What are the most commonly searched types of Anthem Utilization Review Nurse jobs?

The most popular types of Anthem Utilization Review Nurse jobs are:

What states have the most Manager Anthem Utilization Review Nurse jobs?

States with the most job openings for Manager Anthem Utilization Review Nurse jobs include:

Manager Anthem Utilization Review Nurse jobs near you

UTILIZATION REVIEW NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 9 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

498th of 898 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

What Sentara Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply