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Utilization Review Case Manager information

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$15

$33

$54

How much do utilization review case manager jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for utilization review case manager in Alabama is $33.07, according to ZipRecruiter salary data. Most workers in this role earn between $26.78 and $34.86 per hour, depending on experience, location, and employer.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.

What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Review Case Manager jobs in Alabama?

For Utilization Review Case Manager jobs in Alabama, the most frequently searched job titles are:

What job categories do people searching Utilization Review Case Manager jobs in Alabama look for?

The top searched job categories for Utilization Review Case Manager jobs in Alabama are:

What cities in Alabama are hiring for Utilization Review Case Manager jobs?

Cities in Alabama with the most Utilization Review Case Manager job openings:

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Alabama as of August 2026, with employment types broken down into 100% Full Time. Highlights an 93% In-person, and 7% Hybrid job distribution, with an average salary of $68,787 per year, or $33.1 per hour.

Utilization Review Technician

Prime Healthcare

Gadsden, AL

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 18 days ago

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 286 frontline employees who took The Breakroom Quiz

646th of 895 rated healthcare providers

Job description

Department: Social Work Services 

Shifts Available: Days  

Employment Type: Full Time 

Hours: 8-hour shift – 7:30am to 3:30pm 

Location: Riverview Regional Medical Center – Gadsden, AL 

We are seeking an Utilization Review Technician II, sometimes referred to as Utilization Management Technician II or Utilization Review Coordinator II. The Utilization Review Technician II supports the utilization review, appeals, and denial management process by coordinating communication and tracking payer-related activity. This role works closely with insurance providers, health plans, Utilization Review teams, the Business Office, and Case Managers to help ensure timely follow-up on authorizations, reviews, appeals, and denials. The position also assists with payer audits, Release of Information, discharge coordination, and other departmental needs. 


  • Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews, appeals, and denials 
  • Document and track all communication attempts with insurance providers and health plans 
  • Follow up on denials while partnering with Utilization Review, Business Office, and Case Management teams 
  • Maintain accurate tracking of government and payer audits, including RAC, MAC, CERT, ADR, QIO, Medicaid, and pre/post-payment reviews 
  • Provide support with Release of Information, discharge coordination, and other assigned departmental duties 

  • High School Diploma or equivalent
  • Two years of relevant experience
  • Accurate alphabetic, numeric, and/or terminal-digit filing skills
  • Computer data entry with 10-key, with accurate typing speed of 35 wpm
  • Associates Degree or higher, preferred
  • Excel skills. highly preferred
  • Knowledge of terminal digit filing and medical terminology, preferred
  • Knowledge of State and Federal regulatory requirements for medical staff documentation, preferred
  • Completion of a medical terminology course, preferred
  • Background in business and office training, preferred

Here are some of the benefits of working at Prime Healthcare: 

  • Health, dental, and vision insurance options 
  • Paid vacation, sick time and holidays 
  • Bereavement leave, FMLA and other leave options 
  • Employer 401K options 
  • Tuition reimbursement options  
  • Life, disability, and other insurance options 
  • Many other amazing benefits 

Full benefits at Prime Healthcare: https://www.primehealthcare.com/careers/benefits/   

#LI-MP1


Full Time
Days

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

 

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