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Utilization Manager Jobs in Rhode Island (NOW HIRING)

MTM, Inc.

Vendor Account Manager

Warwick, RI · On-site

$47K - $55K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Provide ongoing support to transportation providers regarding claims, payments, eligibility, utilization management or any other questions impacting provider performance * Meet or exceed assigned KPI ...

MTM

Vendor Account Manager

Warwick, RI

$47K - $55K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Provide ongoing support to transportation providers regarding claims, payments, eligibility, utilization management or any other questions impacting provider performance * Meet or exceed assigned KPI ...

Robert Half

Compensation & Benefits Manager

Newport, RI · On-site

$95K - $100K/yr

We are looking for a Compensation & Benefits Manager to lead pay and benefits strategy for our ... Familiarity with self-funded medical plans, claims review, utilization monitoring, and cost-control ...

VNA of Care New England

RN Case Manager

Providence, RI · On-site

Utilization Review * Point of Entry and Emergency Department Duties, when applicable per assignment * Utilization Review for POE/ED RN Case Manager * Resource Allocation for POE/ED RN Case Manager

Abridge Info Systems

Project Manager

Cranston, RI · On-site

At a high level of expertise, manage a team to execute complex professional projects to support ... the utilization of professional standards and techniques. Supervision Exercised: Supervise ...

New

MSCCN

Field Reimbursement Manager - Warwick RI

Warwick, RI · On-site

$100K/yr

  • Medical

  • Retirement

... utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution Educate offices using approved materials Review patient ...

MSCCN

Field Reimbursement Manager - Cranston RI

Cranston, RI · On-site

$100K/yr

  • Medical

  • Retirement

... utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution Educate offices using approved materials Review patient ...

Amgen

Field Reimbursement Manager - Hartford, CT

Warwick, RI · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Offer office education during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and ...

Amgen

Field Reimbursement Manager - Hartford, CT

Cranston, RI · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Offer office education during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and ...

Brown University Health

Social Worker BSW

Riverside, RI · On-site

$50K - $83K/yr

Conducts activities related to Utilization Management, including securing authorizations, concurrent reviews to ensure payment for hospitalization. Works closely with treating physician to address ...

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Showing results 41-60

All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Rhode Island

Utilization Manager information

See Rhode Island salary details

$38.2K

$89.1K

$164K

How much do utilization manager jobs pay per year?

As of Aug 15, 2026, the average yearly pay for utilization manager in Rhode Island is $89,128.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,300.00 and $107,200.00 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 the most commonly searched types of Utilization jobs in Rhode Island?

The most popular types of Utilization jobs in Rhode Island are:

What are popular job titles related to Utilization Manager jobs in Rhode Island?

For Utilization Manager jobs in Rhode Island, the most frequently searched job titles are:

What job categories do people searching Utilization Manager jobs in Rhode Island look for?

The top searched job categories for Utilization Manager jobs in Rhode Island are:

What cities in Rhode Island are hiring for Utilization Manager jobs?

Cities in Rhode Island with the most Utilization Manager job openings:

What are popular job titles related to Utilization Manager jobs in RI?

For Utilization Manager jobs in RI, the most frequently searched job titles are:

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Rhode Island as of August 2026, with employment types broken down into 100% Full Time. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $89,128 per year, or $42.9 per hour.

Case Manager (E)- RWMC

CharterCARE of Rhode Island

Providence, RI • On-site

Full-time

Re-posted 28 days ago

Job description

Main Function

Reports to the Director Care Management or designee.  Provides coordinated care support to Physician leadership and Clinical Manager(s) of respective services.  Makes daily rounds and collaborates with the clinical healthcare team across the patient care continuum to include pre-admission and post hospital discharge.  Participates in the oversight of the progress of a specific patient population.  Performs functions related to Patient Advocacy; Utilization Review; Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization with Care Port to enhance the quality and cost effectiveness of patient care and prevent readmissions.  

 Education/Experience

Graduate of a School of Nursing (BSN preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in the nurse’s primary state of legal residency if that state is a member of the Nurse Licensure Compact.   Five (5) years of clinical experience that includes recent experience with case management, patient navigation, case management, utilization review or discharge planning is strongly preferred.  

Must exhibit strong interpersonal skills as well as a collaborative approach and style of communication in order to interact successfully on a daily basis with a wide and diverse population of both health care providers, patients and their families.

Familiarity with InterQual™ / MCG care management criteria is required.

Must demonstrate knowledge and skill necessary to provide care to patients throughout the life span, with consideration of aging processes, human development stages and cultural patterns in each step of the care process.

A basic proficiency in the use of Microsoft office software programs including email, Outlook calendar and basic keyboard skills are also required.

Center Case Management (CCM) ® board certification or Accredited Case Manager (ACM ™) is highly desirable.

Interrelationships:

         Patient Contact / Age Groups Served:

Check all that apply                       (X) Adolescent (X) Adult          (X) Elder          ( ) N/A

Internal Contacts:   Individual contact with all levels of hospital employees, clinical care teams, physicians, patients, and families/significant others.

External Contacts:   Required to communicate with Post-Acute Care Facilities and agencies, Durable Medical Equipment and Ambulance companies, managed care (insurance) personnel and physician office.

Working Conditions, Physical Environment and/or Safety Requirements: Works in a well-lighted and well-ventilated area.  Must meet annual safety training requirements relative to a safe work place.  Must meet health-testing requirements.  Frequent patient contact requires adherence to standard precautions at all times.  May be required to lift heavy objects weighing 25 pounds from time to time.

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