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Utilization Review Case Manager Jobs in Brick, NJ

Nova Home Care & Staffing

Be Seen First

Registered Nurse Case Manager

Shrewsbury, NJ · On-site

$75K/yr

As a Registered Nurse Case Manager, you will collaborate closely with healthcare professionals to ... Manage utilization review processes by evaluating medical records, and treatment plans to ensure ...

Nova Home Care & Staffing

Be Seen First

Registered Nurse Case Manager

Shrewsbury, NJ · On-site

$75K/yr

As a Registered Nurse Case Manager, you will collaborate closely with healthcare professionals to ... Manage utilization review processes by evaluating medical records, and treatment plans to ensure ...

Encompass Health

Case Manager

Toms River, NJ

$20.25 - $26/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Encompass Health

Case Manager

Tinton Falls, NJ

$21.25 - $27.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Apis Services Inc

Case Manager

Brick, NJ · On-site

$20.40/hr

Participate in program planning, coordination, and service-review activities. * Perform other job ... The Case Manager is required to drive program participants to appointments and other approved ...

PONOS MGMT INC

New Jersey-RN Case Manager

Monmouth, NJ · Remote

$45 - $60/hr

... emergency department utilization while enhancing quality metrics (HEDIS/STAR) and member ... Participate in interdisciplinary team meetings and case reviews to align on care strategies and ...

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Utilization Review Case Manager information

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$39

$64

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

As of Aug 28, 2026, the average hourly pay for utilization review case manager in Brick, NJ is $39.39, according to ZipRecruiter salary data. Most workers in this role earn between $31.92 and $41.54 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 job categories do people searching Utilization Review Case Manager jobs in Brick, NJ look for?

The top searched job categories for Utilization Review Case Manager jobs in Brick, NJ are:

What cities near Brick, NJ are hiring for Utilization Review Case Manager jobs?

Cities near Brick, NJ 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 Brick, NJ as of August 2026, with employment types broken down into 56% Full Time, and 44% Contract. Highlights an 100% In-person job distribution, with an average salary of $81,921 per year, or $39.4 per hour.

Utilization Review Coordinator - Behavioral Health

Avenues Recovery

Toms River, NJ • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 11 days ago

Job description

Avenues Recovery Center is Now Hiring: Utilization Review Specialists
Avenues Recovery Center is a nationwide network of drug and alcohol rehabilitation centers with eighteen locations across seven states. We provide highly individualized, evidence-based treatment in clean, modern settings across all levels of care including detox, residential, PHP, IOP, and outpatient services.
Our success is driven by our people and a strong clinical model that has helped transform thousands of lives. We are seeking a Utilization Review Specialist to join our corporate team in New Jersey and support authorization, clinical documentation integrity, and continued stay coordination across our network.
Position Overview
Location: Corporate office - New Jersey
Schedule: Full-time
The Utilization Review Specialist ensures timely authorization of client services, supports appropriate level-of-care determinations, and partners closely with clinical and billing teams to maintain accurate documentation and continuity of care across facilities.
This role requires strong communication, attention to detail, and the ability to collaborate across clinical, administrative, and billing departments.
Key Responsibilities
Utilization Review & Authorization Management
  • Field incoming calls, emails, and documentation requests related to client authorizations
  • Ensure timely approval and continuation of services at the appropriate level of care
  • Manage client caseloads and support authorization workflows across facilities
  • Advocate for continued stay based on clinical documentation and treatment needs
Clinical & Billing Collaboration
  • Work closely with billing and clinical teams to identify and resolve authorization issues
  • Communicate with facility leadership regarding UR status and documentation needs
  • Support coordination between treatment teams and administrative departments
Documentation & Compliance
  • Maintain accurate electronic records of all UR activity and authorization communications
  • Ensure documentation meets internal standards and payer requirements
  • Assist in identifying gaps in charting and supporting improvements in documentation workflows
Systems & Process Improvement
  • Assist in creating standardized templates and UR workflows across facilities
  • Work with site leaders to ensure consistent implementation of processes
  • Support improvement of internal UR systems and efficiency initiatives
Qualifications
Required / Preferred Education
  • High school diploma or GED required
  • Bachelor's degree preferred
  • Nursing background, clinical background or healthcare knowledge strongly preferred
Experience
  • Minimum 1 year of experience in behavioral health, healthcare, or treatment setting preferred
  • Experience with utilization review, insurance authorization, or medical billing strongly preferred
Core Skills
  • Strong communication (written and verbal)
  • Excellent interpersonal and collaboration skills
  • Strong attention to detail and documentation accuracy
  • Ability to manage multiple cases and deadlines
  • Sound judgment and critical thinking
  • Flexible, team-oriented, and adaptable in a fast-paced environment

Willing to train
Why Join Avenues?
At Avenues, our people are our greatest strength. We foster a culture of support, collaboration, and purpose-driven work, where every team member is valued and empowered to make an impact.
We provide the tools, resources, and benefits needed to help you succeed both personally and professionally.
Comprehensive Benefits
  • 401(k) with employer match
  • Medical, Dental, and Vision Insurance
  • Accident, Critical Illness, and Hospital Indemnity coverage
  • Employer-paid Life and AD&D Insurance
  • Short- and Long-Term Disability options
  • Legal coverage and Identity Theft Protection
  • Pet Insurance
  • Employee Assistance Program (EAP)
  • Flexible Spending Accounts (Medical & Dependent Care)

Join our growing team and discover the magic here at Avenues!
Apply today!

Apply