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Manager Utilization Management Jobs in Ohio (NOW HIRING)

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Manager Utilization Management information

See Ohio salary details

$37.1K

$86.5K

$159.2K

How much do manager utilization management jobs pay per year?

As of Aug 4, 2026, the average yearly pay for manager utilization management in Ohio is $86,524.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,600.00 and $104,100.00 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 Ohio? The most popular types of Utilization Management jobs in Ohio are:
What are popular job titles related to Manager Utilization Management jobs in Ohio? For Manager Utilization Management jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Ohio look for? The top searched job categories for Manager Utilization Management jobs in Ohio are:
What cities in Ohio are hiring for Manager Utilization Management jobs? Cities in Ohio with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Ohio as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $86,524 per year, or $41.6 per hour.

Manager- Utilization Management

MetroHealth

Cleveland, OH

Full-time

Posted 6 days ago

Job description

Location: METROHEALTH MEDICAL CENTER
Biweekly Hours: 80.00
Shift: 7a-330p
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.
Summary:
Organizes and manages the activties of the Utilization Review department specifically focusing on clinical utilization reviews, timeliness, accuracy, and denial prevention. Oversees the application of clinical criteria to ensure medical necessity, correct patient status and level of care. Works with payors and providers to establish and maintain processes that ensure accurate and timely utilization review that is consistent with contractual agreements. Collaborates with MH Admissions and Financial Clearance department to develop and revise processes to meet regulatory and payor requirements. Serves as a clinical resource to the physician group and Utilization Review team and support staff and management. Upholds the standards of the system-wide customer service program.
Qualifications:
Registered Nurse with valid Ohio licensure. Bachelor's Degree in Nursing. Four years equivalent work experience in utilization review/case management may be considered in lieu of degree. Five years experience in case management to include experience with medical necessity criteria, such as Inter Qual and MCG. Strong analytical and trouble shooting skills. Strong communication skills. Strong computer skills including excel and word. Ability to interact effectively with a wide range of cultural, ethnic, racial, and socioeconomic backgrounds. Preferred: EPIC experience. Master's degree in related field. Supervisory experience. Physical Requirements: May sit, stand, stoop, bend, and ambulate intermittently during the day. May need to sit or stand for extended periods. See in the normal visual range with or without correction. Hear in the normal audio range with or without correction. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Ability to use computer. Ability to communicate in face-to-face, phone, email, and other communications. Ability to read job-related documents.

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