Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
Utilization Management Nurse
Nashville, TN · On-site
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
Utilization Management Nurse
Nashville, TN · On-site
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating ...
Utilization Review activities include inpatient, observation, outpatient in a bed, ambulatory surgery, and Point-of-Entry Utilization review/case management activities. This role is crucial in ...
Utilization Review activities include inpatient, observation, outpatient in a bed, ambulatory surgery, and Point-of-Entry Utilization review/case management activities. This role is crucial in ...
Utilization Review activities include inpatient, observation, outpatient in a bed, ambulatory surgery, and Point-of-Entry Utilization review/case management activities. This role is crucial in ...
Utilization Review activities include inpatient, observation, outpatient in a bed, ambulatory surgery, and Point-of-Entry Utilization review/case management activities. This role is crucial in ...
The Utilization Review Care Manager is responsible for the direction, management and monitoring of activities related to Quality and Process Improvement, Case Management, Clinical Pathway Development ...
The Utilization Review Care Manager is responsible for the direction, management and monitoring of activities related to Quality and Process Improvement, Case Management, Clinical Pathway Development ...
The Utilization Review Care Manager is responsible for the direction, management and monitoring of activities related to Quality and Process Improvement, Case Management, Clinical Pathway Development ...
The Utilization Review Care Manager is responsible for the direction, management and monitoring of activities related to Quality and Process Improvement, Case Management, Clinical Pathway Development ...
Utilization Review Manager
Cookeville, TN · On-site
The Utilization Management Manager is responsible for overseeing the organization's utilization review functions to ensure appropriate, cost-effective use of healthcare services. This role leads a ...
Utilization Review Manager
Cookeville, TN · On-site
The Utilization Management Manager is responsible for overseeing the organization's utilization review functions to ensure appropriate, cost-effective use of healthcare services. This role leads a ...
Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and quarterly utilization reports, including reports for the Utilization Management Committee. * Communicate ...
Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and quarterly utilization reports, including reports for the Utilization Management Committee. * Communicate ...
Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and quarterly utilization reports, including reports for the Utilization Management Committee. * Communicate ...
New
Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and quarterly utilization reports, including reports for the Utilization Management Committee. * Communicate ...
New
Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and quarterly utilization reports, including reports for the Utilization Management Committee. * Communicate ...
New
Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and quarterly utilization reports, including reports for the Utilization Management Committee. * Communicate ...
New
Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and quarterly utilization reports, including reports for the Utilization Management Committee. * Communicate ...
New
Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and quarterly utilization reports, including reports for the Utilization Management Committee. * Communicate ...
New
Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and quarterly utilization reports, including reports for the Utilization Management Committee. * Communicate ...
New
Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and quarterly utilization reports, including reports for the Utilization Management Committee. * Communicate ...
New
VP of Utilization Review
Franklin, TN · On-site +1
This executive leader is responsible for developing, standardizing, optimizing, and overseeing utilization management practices that support quality care, appropriate reimbursement, regulatory ...
VP of Utilization Review
Franklin, TN · On-site +1
This executive leader is responsible for developing, standardizing, optimizing, and overseeing utilization management practices that support quality care, appropriate reimbursement, regulatory ...
This executive leader is responsible for developing, standardizing, optimizing, and overseeing utilization management practices that support quality care, appropriate reimbursement, regulatory ...
This executive leader is responsible for developing, standardizing, optimizing, and overseeing utilization management practices that support quality care, appropriate reimbursement, regulatory ...
Utilization Specialist
Burns, TN · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
Utilization Specialist
Burns, TN · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Act as liaison between managed care organizations and the facility professional clinical staff.
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Act as liaison between managed care organizations and the facility professional clinical staff.
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction; Care ...
Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction; Care ...
Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise ...
Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise ...
Manager Utilization Management information
See Tennessee salary details
$35.4K - $46K
9% of jobs
$53.8K is the 25th percentile. Wages below this are outliers.
$46K - $56.6K
22% of jobs
$56.6K - $67.2K
11% of jobs
The median wage is $73.7K / yr.
$67.2K - $77.8K
14% of jobs
$77.8K - $88.4K
12% of jobs
$95K is the 75th percentile. Wages above this are outliers.
$88.4K - $99K
13% of jobs
$99K - $109.6K
13% of jobs
$109.6K - $120.2K
5% of jobs
$120.2K - $130.8K
2% of jobs
$130.8K - $141.4K
0% of jobs
$141.4K - $152K
0% of jobs
$35.4K
$82.6K
$152K
How much do manager utilization management jobs pay per year?
As of Jul 15, 2026, the average yearly pay for manager utilization management in Tennessee is $82,603.00, according to ZipRecruiter salary data. Most workers in this role earn between $54,000.00 and $99,400.00 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?
| Aspect | Manager Utilization Management | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, often with management or utilization review certifications | RN, with certifications in utilization review or case management |
| Work Environment | Supervises teams, manages policies, oversees utilization review processes | Performs patient chart reviews, assesses medical necessity, collaborates with providers |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare organizations |
| Search & Comparison Intent | Yes | Yes |
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 Tennessee? The most popular types of Utilization Management jobs in Tennessee are:
What are popular job titles related to Manager Utilization Management jobs in Tennessee? For Manager Utilization Management jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Tennessee look for? The top searched job categories for Manager Utilization Management jobs in Tennessee are:
What cities in Tennessee are hiring for Manager Utilization Management jobs? Cities in Tennessee with the most Manager Utilization Management job openings:
Other
Posted 5 days ago
Job description
Job Summary:
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating medical services, treatments, and procedures. This role identifies trends for opportunities to educate and collaborate with healthcare providers, patients, and specialists to optimize resource utilization and improve patient outcomes.
Duties/Responsibilities:
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- Conducts prospective, concurrent, and retrospective utilization reviews for medical necessity to ensure treatment and services are appropriate and necessary by reviewing medical records and treatment plans.
- Works collaboratively with healthcare providers and Medical Directors to provide guidance on approvals or requests for health plan determination reviews as applicable utilizing CMS clinical guidelines and insurance policies.
- Maintains accurate and detailed records of reviews, interventions, and communications to ensure adherence to health plan requirements and organizational policies.
- Analyze utilization trends to ensure progress towards organizational goals
- Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
- Collaborates with Network and specialists to identify opportunities to educate on value-based care, resolve specialty gaps by markets, improve cost-effectiveness and coordination of care to meet patient needs.
Required Skills/Abilities:
- Strong knowledge of utilization management functions in value-based care, including data analysis, claims review, reimbursement practices, and medical records reviews.
- Thorough, in-depth knowledge of evidence-based practice, legal rules and regulations and best practices in healthcare
- Ability to effectively leverage business and organizational knowledge within and across functional areas
- Must possess a high degree of emotional intelligence and integrity, driven and focused work ethic
- Continuous desire to learn and embrace new methods; ability to adapt and be resilient.
- Self-starter with the ability to think creatively and work effectively
- Ability to build a relationship and work effectively with various seniorities and diverse populations.
- Excellent critical reasoning, decision-making, and problem-solving skills to make informed decisions and ensure effective resource utilization while maintaining quality patient care.
- Willingness and ability to travel, up to 20%
Education and Experience:
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- AA/AS degree in Nursing required; BA/BS degree in Nursing (BSN) or Healthcare Administration preferred
- A valid, active Registered Nurse (RN) license in state(s) of employment required
- A minimum of 3 years’, current direct utilization management requiredÂ
- Work in an acute care facility, community-based clinic, public health department or specialization with the senior population preferred
- Proficient PC skills
- Fluency in Spanish or other languages spoken by people in the communities we serve is desirable, but not required
ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.