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Manager Utilization Management Jobs in New York (NOW HIRING)

Medix

Director of Utilization Management

Manhattan, NY · On-site

$109.15 - $151.44/hr

Responsible for oversight of utilization management services and resources through case reviews, peer reviews, and appeals. * Document all case reviews utilizing the care management system.

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Manager Utilization Management information

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 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 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 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 the most commonly searched types of Utilization Management jobs in New York?

The most popular types of Utilization Management jobs in New York are:

What are popular job titles related to Manager Utilization Management jobs in New York?

For Manager Utilization Management jobs in New York, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in New York look for?

The top searched job categories for Manager Utilization Management jobs in New York are:

What cities in New York are hiring for Manager Utilization Management jobs?

Cities in New York with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in New York as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% In-person job distribution.

Utilization Management Registered Nurse

St. Joseph's Health

Paterson, NJ • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 2 days ago. Applications are no longer accepted.

St. Joseph's Health (New Jersey) rating

7.7

Company rating: 7.7 out of 10

Based on 47 frontline employees who took The Breakroom Quiz

165th of 898 rated healthcare providers

Job description

The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and organizational role. The UM RN ensures optimal patient care delivery while supporting compliance, quality outcomes, and effective resource utilization.  The role is responsible for the assessment of medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate but ensures that an authorization is obtained from the payer, if required, and that the documentation supports the care delivered in such a way that minimizes risks of denials.

St. Joseph's Health is recognized for the expertise and compassion of its highly skilled and responsive staff. The combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care".

Benefits Eligibility: (Full-time and Part-time Employees-over 20 hours a week)

  • Competitive salary*
  • Robust benefits with health, dental, Rx and vision plans
  • 403b retirement plan options with company match**
  • Health & Wellness*
  • Non-Profit Health System - eligible for Federal Student Loan Forgiveness
  • PTO, and paid holidays
  • Tuition reimbursement
  • Employee Assistance Program
  • LTD : Long Term Disability
  • Life Insurance Options
  • Onsite Day care Program

*Available for Per Diem Employees and Part-time Employees working under 20 hours per week.

**403b Company Match not applicable for Per Diem Employees and Part-time Employees working under 20 hours per week.

Pay transparency:  St. Joseph's Health provides a salary range to comply with New Jersey Law.  The rate of pay for each position will be determined based on a variety of factors including the candidate's relevant experience, qualifications, skills, etc." The salary range does not include incentives, differential pay or other forms of compensation.


St. Joseph's University Medical Center is an academic tertiary care medical center and state designated trauma center, located on the Paterson campus, regularly accepts referrals of difficult or unusual cases from other hospitals and physicians and performs both complex and routine procedures. 

The Medical Center offers a full complement of specialty and subspecialty services including ambulatory, behavioral health, cardiovascular, emergency/trauma, internal medicine, neuroscience, oncology, orthopedic/spine, rehabilitation, surgical specialty, women's health, imaging and pediatrics. 

The nursing team at St. Joseph's University Medical Center, which includes St. Joseph's Children's Hospital, has held the Magnet Award for Nursing Excellence, the profession's highest honor, since 1999. They are also recipients of the prestigious 2010 Magnet Prize - one of only 8 Magnet-designated hospitals to ever receive The Magnet Prize, and the only one worldwide to receive the 2010 award.


Work requires the knowledge of theories, principles, and concepts normally acquired through completion of a Bachelor of Science in Nursing and least at least 3 years of previous nursing experience. Preferred 3+ years of Utilization Review or Case Management experience.  Case Management Society of America Certification CCM preferred. Licensure required as a Registered Nurse by the State of New Jersey.

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