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Manager Utilization Management Jobs in Kentucky (NOW HIRING)

Humana

Utilization Management RN

Frankfort, KY · On-site

This role will report directly to the Manager, Utilization Management. Key Responsibilities: Clinical Review: · Conduct comprehensive clinical reviews of prior authorization requests to determine ...

UHS

Utilization Coordinator PRN

Louisville, KY

$20/hr

The UM Coordinator is responsible for managing and coordinating the treatment activities offered to ... Required: One year of experience in Utilization Management Preferred: Three to five years of ...

UHS

Utilization Coordinator PRN

Louisville, KY · On-site

$20/hr

The UM Coordinator is responsible for managing and coordinating the treatment activities offered to ... Required: One year of experience in Utilization Management Preferred: Three to five years of ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Kentucky

Manager Utilization Management information

See Kentucky salary details

$33.9K

$79K

$145.5K

How much do manager utilization management jobs pay per year?

As of Aug 11, 2026, the average yearly pay for manager utilization management in Kentucky is $79,046.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,700.00 and $95,100.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

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

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the most commonly searched types of Utilization Management jobs in Kentucky? The most popular types of Utilization Management jobs in Kentucky are:
What are popular job titles related to Manager Utilization Management jobs in Kentucky? For Manager Utilization Management jobs in Kentucky, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Kentucky look for? The top searched job categories for Manager Utilization Management jobs in Kentucky are:
What cities in Kentucky are hiring for Manager Utilization Management jobs? Cities in Kentucky with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Kentucky as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $79,046 per year, or $38 per hour.

Manger Utilization Management & Quality, Peace Hosptial

UofL Health

Louisville, KY • On-site

Other

Posted 4 days ago

Job description

Primary Location:
Peace - Louisville
Address:
2020 Newburg Rd.Louisville, KY 40205
Shift:
First Shift (United States of America)
Job Description Summary:
About UofL Health:
UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehabilitation Institute and Brown Cancer Center.
With more than 12,000 team members-physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals-UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.
Job Description:
Position Summary and Purpose
The Manager of Utilization Management (UM) leads the strategic and operational oversight of utilization review and management across the academic healthcare system. This role ensures appropriate resource utilization, regulatory compliance, and alignment with clinical and financial goals. The Manager collaborates with medical staff, case management, revenue cycle, and IT to optimize care delivery and reimbursement.
Essential Functions:
1. Manage the day-to-day operations of the utilization review staff, including training, performance evaluation, and setting performance standards.
2. Create, implement, and maintain policies and procedures for the UM program, ensuring they align with regulations and organizational goals
3. Analyze UM metrics, identify trends, and prepare reports for senior management or quality improvement committees to guide decision-making and demonstrate the impact of the program.
4. Monitor the clinical review process to ensure patient care is appropriate, effective, and timely, and collaborate with physicians, case management and other professionals to improve utilization.
5. Identify opportunities to enhance the efficiency and accuracy of UM processes, often by working with physician advisors, case management, nursing leadership, and revenue cycle.
6. Ensure the department complies with all applicable state and federal guidelines and manage audits from regulatory agencies or health plans.
7. Provide mentorship, training and performance evaluations.
8. Ensure accurate documentation and data capture for billing and compliance.
9. Facilitate secondary reviews and appeals processes.
10. Performs other duties as assigned.
Other Functions:
• Participate in UM system-wide UM committees and initiatives.
• Analyze utilization trends and recommend process improvements.
• Coordinate certified training programs (e.g., InterQual, MCG).
• Partner with IT to optimize UM-related systems (e.g., EMR, InterQual).
Additional Job Description:
Job Requirements
(Education, Experience, Licensure and Certification)
Education: Bachelor's degree in nursing or related field, master's degree preferred.
License: Active RN license or LCSW required to practice in the state of Kentucky.
Certification: Case/Utilization Management (e.g., ACM, CCM, CMAC).
Experience: Minimum seven years of UM/Case Management experience in an acute care of academic health system. Minimum 4 years leadership experience.
Job Competency:
Knowledge, Skills, and Abilities critical to this role:
• Strategic thinking
• Deep understanding of clinical workflows and regulatory requirements.
• Strong communication and stakeholder engagement skills.
• Data-driven decision-making and continuous improvement mindset.
UofL Health Core Expectation:
At UofL Health, we expect all our employees to live the values of honesty, integrity and compassion and demonstrate these values in their interactions with others and as they deliver excellent patient care by:
• Honoring and caring for the dignity of all persons
• Ensuring the highest quality of care for those we serve
• Working together as a team to achieve our goals
• Improving continuously by listening, and asking for and responding to feedback
• Seeking new and better ways to meet the needs of those we serve
• Using our resources wisely
• Understanding how each of our roles contributes to the success of UofL Health

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