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Utilization Manager Jobs in Walton, KY (NOW HIRING)

New Vista Behavioral Health

UM Coordinator

Cincinnati, OH · On-site

$18 - $24/hr

Position Summary The Utilization Management (UM) Coordinator supports the facility's utilization review and authorization processes for patients receiving mental health and behavioral health services.

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Utilization Manager information

See Walton, KY salary details

$36K

$84K

$154.5K

How much do utilization manager jobs pay per year?

As of Aug 26, 2026, the average yearly pay for utilization manager in Walton, KY is $83,964.00, according to ZipRecruiter salary data. Most workers in this role earn between $54,900.00 and $101,000.00 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 cities near Walton, KY are hiring for Utilization Manager jobs?

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

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Walton, KY as of August 2026, with employment types broken down into 87% Full Time, 12% Part Time, and 1% Contract. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution, with an average salary of $83,964 per year, or $40.4 per hour.

Clinical Services Utilization Supervisor

Cincinnati, OH • On-site

CareStar, Inc.
Health Care and Social Assistance • 201 - 500 employees
Learn more about CareStar, Inc.external

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 26 days ago

Job description

Case Manager - Hamilton & Surrounding Counties
Company: CareStar, Inc.
Location: Hamilton County, Ohio (and surrounding areas)
Job Type: Full Time | Remote with Field Visits
Industry: Healthcare / Social Services / Case Management
About the Opportunity at CareStar
Founded in 1988 in Cincinnati, Ohio, CareStar, Inc. is a recognized leader in long-term care case management and population health. With a mission to Improve Communities by Improving Lives, we proudly serve individuals across Ohio through compassionate, high-quality care coordination. We are currently seeking Clinical Services Utilization Supervisor to join our Ohio Home Care program. This is a meaningful opportunity for professionals who are passionate about helping others live healthier, more independent lives. As a Clinical Services Utilization Supervisor, you'll work directly with individuals to assess their needs, develop personalized care plans, and connect them with essential services and supports. You'll be part of a mission-driven team that values your expertise, supports your growth, and empowers you to make a real difference in your community.
Key Responsibilities
  • Monitor service delivery and ensure compliance with program guidelines
  • Serve as the lead advocate and care coordinator for each participant
  • Educates, guides, oversees, and counsel's clinical employees in the performance of task related to Due Process and Prior Authorizations.
  • Formulates training material for Due Process and Prior Authorizations and conducts training for Clinical Team as necessary.
  • Provides guidance to staff related to applicable rule reference and disenrollment determinations; identifies problematic cases and refers to the Clinical Supervisor and/or Clinical Manager as appropriate.
  • Maintains/updates knowledge of Medicare, Medicaid, insurance and program and State specific waivers; maintains knowledge of the Americans with Disabilities Act.
  • Understands current and future state and other program information to assist with business objectives; establishes rapport with State and other programs employees.
  • Prepares appeal summaries and exhibits list for processing to be presented at hearing; represents CareStar at appeal hearings; be available to provide testimony at appeal hearings.
  • Reviews hearing rights for appropriateness and submits them for processing to ensure compliance with the State administrative code.
  • Reviews hearing decisions and coordinates compliance with the determination, prepares and submits compliance forms per requirements, including issuance of hearing rights.
  • Provides support to staff in assessing need for prior authorization and assures that determination is supported by medical necessity; reviews prior authorizations prior to submissions to state specific Department of Medicaid for completeness and compliance with the state specific administrative code and CareStar requirements.
  • Adhere to the CareStar Rule in performance of job responsibilities.
  • Understand and comply with CareStar Policies and Procedures.
  • Maintain confidentiality as related to patient information. Any disclosures of confidential information made unlawfully outside the proper course of duty will be treated as a serious disciplinary offense.
  • Follow the Acceptable Use Policy while using any information systems owned or controlled by CareStar, Inc.

Minimum Qualifications
  • Bachelor's degree in Social Work, Counseling, Psychology, Nursing, or a related field and at least three (3) years of either pediatric, Developmental Disabilities or mental health experience within the last ten (10) years is desirable.
  • Licensed Social Worker (LSW), Licensed Independent Social Worker (LISW) or Registered Nurse (RN)
  • Minimum 3 year of experience in home and community-based services (within the last 10 years)
  • Experience working with individuals with chronic conditions or severe and persistent mental illness
  • Strong knowledge of Medicaid, behavioral health systems, and local community resources

Why Join CareStar?
  • Remote flexibility with meaningful community engagement
  • Competitive salary based on experience and education
  • Comprehensive benefits: Medical, dental, vision, life insurance
  • 401(k) with a generous company match
  • Paid time off + 10 paid holidays
  • Employee Stock Ownership Plan (ESOP) - become a part-owner in the company
  • Supportive, mission-driven culture focused on improving lives

Apply Today
Ready to make a difference? Visit https://www.carestar.com/about-carestar/careers/ to apply and learn more about joining our team.
Department Ohio Clinical Role Case Manager Locations Hamilton County Employment type Full-time

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