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Utilization Manager Jobs in Lexington, KY (NOW HIRING)

Phenom People

RN Utilization Review PRN

Paris, KY · On-site

PRN, RN - Utilization Review Making Communities Healthier with Comprehensive Care... You can get to know who we are and what truly makes us different by our mission, 'Making Communities Healthier'

Pharmacy Careers

Appeals Pharmacist (Remote)

Lexington, KY · On-site

$50 - $61/hr

Experience: Managed care or utilization management preferred. Hospital, ambulatory, and community pharmacists with strong documentation and clinical skills are encouraged to apply. * Skills:

Pharmacy Careers

Formulary Management Pharmacist

Lexington, KY · On-site

$51 - $61.25/hr

Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...

Lexington Legends

Parking Attendant

Lexington, KY · On-site

$13 - $15.50/hr

Key Responsibilities and Characteristics: -Directs cars to designated spaces using hand signals, flashlights, or traffic wands to optimize space utilization. -Manages flow during peak entry/exit ...

KCO Resource Management

Plant Manager

Lexington, KY · On-site

$140K - $160K/yr

The Plant Manager will play a critical role in scaling operations, developing talent, improving ... Drive improvements in labor utilization, manufacturing costs, inventory control, and asset ...

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All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Lexington, KY

Utilization Manager information

See Lexington, KY salary details

$33.8K

$78.9K

$145.2K

How much do utilization manager jobs pay per year?

As of Aug 26, 2026, the average yearly pay for utilization manager in Lexington, KY is $78,894.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,600.00 and $94,900.00 per year, depending on experience, location, and employer.

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 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 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 job categories do people searching Utilization Manager jobs in Lexington, KY look for?

The top searched job categories for Utilization Manager jobs in Lexington, KY are:

What cities near Lexington, KY are hiring for Utilization Manager jobs?

Cities near Lexington, KY with the most Utilization Manager job openings:

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Lexington, KY as of August 2026, with employment types broken down into 85% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $78,894 per year, or $37.9 per hour.

RN Utilization Review PRN

Phenom People

Paris, KY • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 5 days ago

Job description

PRN, RN - Utilization Review

Making Communities Healthier with Comprehensive Care...

You can get to know who we are and what truly makes us different by our mission, 'Making Communities Healthier'. As health care evolves, Bourbon Community Hospital is transforming patient safety and quality care - pushing the limits and paving the way to establish new practices and set new standards. We believe in putting the patient at the center of everything we do. We are developing the most innovative patient experiences with our constant investment in continuing education and leadership development programs.

We want you on our team...Bourbon Community Hospital located in Paris, a 20 minute drive from Lexington, KY is searching for a PRN, RN - Utilization Review, who monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions and extended hospital stays.

We are committed to serving the needs of our community and our region with exceptional quality and we are passionately focused on our patients. We consider quality more than just a set of criteria. It is a way of life for Bourbon Community, encompassing everything we do. This is an exciting time to join our team as we continue to grow and expand with new services.

At Bourbon Community, we believe in building careers. That is why we offer an excellent tuition reimbursement program, competitive pay, a generous paid time off program, flexible spending account plan, choice of health insurance plans, dental, vision, life, disability plans, discounts in our café and various discounts in our community, traditional and Roth 401 (k) plans with a match, and free parking on our beautiful campus.

Simply put, our employees are the heart and soul of our organization.

Essential functions of position include, but are not limited to:

  • Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of all hospital admissions.
  • Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.
  • Calculates the lengths of stay and continued-stay days for patients.
  • Maintains a liaison with the Social Service Department to facilitate timely discharge planning.

Minimum Education

Associate's degree - Required

Bachelor's degree - Preferred

Required Skills

Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Certifications:

Handle With Care

Licenses:

RN in the state of Kentucky

Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran

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