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Utilization Manager Jobs in Kentucky (NOW HIRING)

Med Center Health

Insurance Specialist

Bowling Green, KY · On-site

$11.55/hr

Serves as a resource to Utilization Management by initiating the patient intake, insurance verification and authorization processes to ensure that care is provided in the correct setting with proper ...

Abilis Health Plan

Chief Medical Officer

Louisville, KY · On-site +1

Oversee utilization management, including prior authorization criteria, medical necessity determinations, concurrent review, and appeals, ensuring evidence based and compliant decision making. * Lead ...

BrightSpring

Chief Medical Officer

Louisville, KY · On-site

Oversee utilization management, including prior authorization criteria, medical necessity determinations, concurrent review, and appeals, ensuring evidence based and compliant decision making. * Lead ...

UHS

UR COORDINATOR (RN OR MSW)

Hopkinsville, KY · On-site

Maintain accurate utilization review and authorization records. * Assist with denial management, appeals, and peer reviews. * Ensure compliance with payer, regulatory, and hospital requirements.

Taphealthcare

Director of Case Management

Mayfield, KY · On-site

$95K - $125K/yr

Accredited Case Manager (ACM) certification through ACMA, or ability to obtain the required certification within two (2) years of hire. * Strong understanding of care coordination, utilization ...

UHS

UR COORDINATOR (RN OR MSW)

Hopkinsville, KY · On-site

Maintain accurate utilization review and authorization records. * Assist with denial management, appeals, and peer reviews. * Ensure compliance with payer, regulatory, and hospital requirements.

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Showing results 21-40

All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Kentucky

Utilization Manager information

See Kentucky salary details

$33.9K

$79K

$145.5K

How much do utilization manager jobs pay per year?

As of Aug 5, 2026, the average yearly pay for utilization manager in Kentucky is $79,046.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,700.00 and $95,100.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a utilization manager?

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What are some common challenges faced by utilization managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What is a utilization manager?

A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound in similar settings, often working under Utilization Managers

In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

More about Utilization Manager jobs
What are popular job titles related to Utilization Manager jobs in Kentucky? For Utilization Manager jobs in Kentucky, the most frequently searched job titles are:
What job categories do people searching Utilization Manager jobs in Kentucky look for? The top searched job categories for Utilization Manager jobs in Kentucky are:
What cities in Kentucky are hiring for Utilization Manager jobs? Cities in Kentucky with the most Utilization Manager job openings:
What are popular job titles related to Utilization Manager jobs in KY? For Utilization Manager jobs in KY, the most frequently searched job titles are:
Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Kentucky as of July 2026, with employment types broken down into 83% Full Time, 15% Part Time, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $79,046 per year, or $38 per hour.

Case Management Social Worker / Nurse Case Manager - Weekday PRN

Jennie Stuart Health

Hopkinsville, KY • On-site

$21.75 - $28.50/hr

Other

Posted 14 days ago

Jennie Stuart Health rating

7.0

Company rating: 7.0 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

Jennie Stuart Health is seeking a qualified Case Management Social Worker or Registered Nurse Case Manager to join our Case Management team. This position supports the physician, patient/family, and interdisciplinary care team by coordinating discharge planning, utilization management, resource coordination, and patient advocacy throughout the continuum of care.

The ideal candidate will have strong clinical judgment, excellent communication skills, and the ability to work collaboratively with patients, families, physicians, payers, and internal care teams to ensure safe, timely, and effective discharge planning. This role is essential in promoting quality outcomes, efficient resource utilization, patient satisfaction, and continuity of care.

Key Responsibilities:

  • Coordinate discharge planning and post-acute care needs for assigned patients.
  • Conduct timely initial and follow-up assessments to identify medical, psychosocial, financial, and discharge barriers.
  • Collaborate with physicians, nursing, social workers, case managers, and other interdisciplinary team members to support patient progression.
  • Assist with utilization management, medical necessity review, and appropriate patient status determination.
  • Educate patients and families regarding discharge plans, community resources, and available support services.
  • Serve as a patient advocate while supporting safe and quality-driven transitions of care.
  • Communicate barriers to discharge, delays, payer concerns, and other key case management factors to the appropriate team members.
  • Maintain accurate and timely documentation in accordance with hospital, state, federal, and regulatory guidelines.
  • Support process improvement efforts related to length of stay, readmissions, discharge times, patient flow, and overall case management metrics.
  • Provide excellent customer service and professional hand-off communication.

Minimum Qualifications:

Candidates may qualify through either of the following pathways:

Social Worker Pathway:

  • Bachelor's degree in Social Work required.
  • LSW in the state of Kentucky preferred.
  • Minimum of one year of clinical experience preferred, preferably in an acute-care setting.
  • Knowledge of discharge planning, social work concepts, community resources, and performance improvement preferred.

Nurse Case Manager Pathway:

  • Graduate of an accredited nursing program required.
  • Associate degree in Nursing required; Bachelor's degree in Nursing preferred.
  • Current Kentucky RN license required.
  • Minimum of three years of acute care experience preferred, with one year of case management experience preferred.

Preferred Qualifications:

  • ACM or CCM certification preferred, but not required.
  • Current BLS certification through the American Heart Association preferred.
  • Working knowledge of Medicare, Medicare Advantage, Medicaid, commercial insurance, and other third-party reimbursement processes preferred.
  • Strong organizational, problem-solving, customer service, and communication skills.
  • Ability to work in a fast-paced environment while maintaining professionalism, confidentiality, and a patient-centered approach.

Schedule/Classification:

  • Inclement Weather Classification: Essential
  • Patient Population: All Ages

Physical Requirements:

This role may require prolonged periods of standing, walking, sitting, computer work, reaching, bending, stooping, and the ability to lift up to 25 pounds. The position requires normal or corrected hearing and vision, clear oral communication, manual dexterity, and the ability to perform in a fast-paced and stressful environment.

Jennie Stuart Health is an Equal Opportunity Employer.

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