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Utilization Manager Jobs in Newark, NJ (NOW HIRING)

Pride Health

Utilization Review Nurse

Manhattan, NY · On-site

$60 - $61/hr

Care Manager (RN) - Non-Patient-Facing - MLTC Location: New York, NY 10004 Schedule: Monday-Friday ... Perform utilization review and discharge planning. * Collaborate with providers and ...

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All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Newark, NJ

Utilization Manager information

See Newark, NJ salary details

$40.8K

$95.2K

$175.2K

How much do utilization manager jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization manager 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 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

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

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

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

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

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Newark, NJ as of August 2026, with employment types broken down into 87% Full Time, 11% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote 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 11 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.

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