ZipRecruiter

Log In

1

Manager Utilization Management Jobs in Newark, NJ

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.

previous pagenext page

Showing results 21-40

All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Newark, NJ

Manager Utilization Management information

See Newark, NJ salary details

$40.8K

$95.2K

$175.2K

How much do manager utilization management jobs pay per year?

As of Sep 1, 2026, the average yearly pay for manager utilization management in Newark, NJ is $95,173.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,200.00 and $114,500.00 per year, depending on experience, location, and employer.

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 Newark, NJ?

The most popular types of Utilization Management jobs in Newark, NJ are:

What are popular job titles related to Manager Utilization Management jobs in Newark, NJ?

For Manager Utilization Management jobs in Newark, NJ, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Newark, NJ look for?

The top searched job categories for Manager Utilization Management jobs in Newark, NJ are:

What cities near Newark, NJ are hiring for Manager Utilization Management jobs?

Cities near Newark, NJ with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Newark, NJ as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% In-person job distribution, with an average salary of $95,173 per year, or $45.8 per hour.

Supervisor, Utilization Management Technician

Capital Rx

Manhattan, NY • On-site

$70K - $85K/yr

Other

Posted 9 days ago

Job description

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Location: Hybrid (Local to Denver, CO, Charlotte, NC or NYC area)

Position Responsibilities:

  • Responsible for overseeing a group of prior authorization technicians and expanded responsibility forselectadministrative PA functions.
  • Work in conjunction with the pharmacy technician manager in analyzing available data and provide prior authorization staffing, workflow and system enhancement recommendations.
  • Support on-going training and coaching of utilization management pharmacy technicians.
  • Participate in the goal setting process and regularly review performance of direct reports, addressing performance and behavioral issues when needed.
  • Investigate/resolve escalated issues or problems from clients and providers.
  • Works withutilization managementmanager on other responsibilities, projects,implementationsand initiatives as needed.
  • Review pharmacy claims data for proactive outreach and intervention.
  • Maintain quality and productivity standards for all cases triaged while minimizing compliance risk.
  • Work with business and clinical partners as needed.
  • Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines.
  • Proactively obtains clinical information from prescribers, referral coordinators, andappropriate staffto ensure all aspects of clinical guidelines are addressed for pharmacist review.
  • Identify, document, and escalate provider concerns to the appropriate internal team including various members of the utilization management team.
  • Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
  • Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders.
  • Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies.
  • Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment.
  • Ability to work in a fast-paced environment with shifting priorities, and flexible schedules that may include weekends.
  • Abilityto work flexible schedules that includes an on-call weekendand holidayrotation.

Required Qualifications:

  • Minimum 1 year of Prior Authorization and/or appeals experience
  • Demonstrated ability to communicate effectively and manage team priorities
  • Strong organizational and problem-solving skills
  • Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required
  • Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
  • Strong clinical background required
  • Excellent communication, writing, and organizational skills
  • Ability to multi-task and collaborate in a team with shifting priorities

Preferred Qualifications:

  • 2+ years of leadership experience
  • Strong understanding of CMS regulations and payer requirements
  • 2+ years of PBM or Managed Care pharmacy experience
New York, NY Salary Range
$70,000—$85,000 USD
Denver, CO Salary Range
$70,000—$85,000 USD
Charlotte, NC Salary Range
$70,000—$85,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found athttps://www.judi.health/legal/privacy-policy.

Apply