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Manager Utilization Management Jobs in Ohio (NOW HIRING)

Elevance Health

Utilization Management Rep I

Mason, OH · On-site

Utilization Management RepresentativeI Virtual: This role enables associates to work virtually ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...

Elevance Health

Utilization Management Rep I

Mason, OH

$15 - $20.50/hr

Utilization Management Representative I Virtual: This role enables associates to work virtually ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...

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All JobsManager Utilization Management JobsManager Utilization Management Jobs in Ohio

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 Jun 14, 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, and why are they important?

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 in 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 of 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 June 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $86,524 per year, or $41.6 per hour.
Manager, Utilization Management Medical Director

Manager, Utilization Management Medical Director

Medical Mutual of Ohio

Cleveland, OH • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago

Medical Mutual of Ohio rating

9.4

Company rating: 9.4 out of 10

Based on 15 frontline employees who took The Breakroom Quiz

13th of 261 rated insurance

Job description

Medical Mutual employees must submit their applications through MySource.
This is a hybrid-remote role based out of the Brooklyn, OH office, with employees expected to work onsite on designated in-office days each week.
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Job Summary:
Provides leadership to AMD teams based upon specialty or geographic area and performs utilization management review in area of expertise. Fosters continuous improvement in policies, processes, and all parts of the operations.
Responsibilities:
  • Oversee physician's utilization review process and determinations.
  • Participate in quality processes such as audits and quality improvement projects.
  • Provide leadership support to assistant medical directors
  • Ensure physician compliance with clinical goals through monitoring of care management performance.
  • Recommend changes and enhancements to current managed care, review guidelines, and clinical criteria based on clinical knowledge of health care delivery systems, utilization methods, reimbursement methods and treatment protocols.
  • Provide guidance to assistant medical director team in the coordination of quality care.
  • Performs other duties as assigned.

Qualifications:
Education and Experience:
  • MD or DO from an accredited medical school with an active, unrestricted (state) license to practice medicine in United States
  • Minimum of 5 years of established (clinical) care practice experience required
  • Physician reviewer experience in the insurance industry preferred

Professional Certification(s):
  • Board Certification, in nationally recognized specialty (ABMS or AOA) is required.
  • Active Unrestricted license to practice medicine in US

Technical Skills and Knowledge:
  • Foundational windows-based computer skills, including typing, word processing, presentation, and internet research skills.
  • Strong understanding of integration of evidence-based medicine and managed care principles.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
A Great Place to Work:
  • We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
  • Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
  • On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
  • Discounts at many places in and around town, just for being a Medical Mutual team member.
  • The opportunity to earn cash rewards for shopping with our customers.
  • Business casual attire, including jeans.

Excellent Benefits and Compensation:
  • Employee bonus program.
  • 401(k) with company match up to 4% and an additional company contribution.
  • Health Savings Account with a company matching contribution.
  • Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
  • Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
  • Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
  • After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:
  • Career development programs and classes.
  • Mentoring and coaching to help you advance in your career.
  • Tuition reimbursement up to $5,250 per year, the IRS maximum.
  • Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:
Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
We're not just one of the largest health insurance companies based in Ohio; we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
#LI-CS1 #LI-HYBRID
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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