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Utilization Review Case Manager Jobs in Windham, ME

Health Affiliates Maine

Veterans Case Manager

Auburn, ME · On-site

$21.50 - $27.75/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Case Managers will work collaboratively with Veterans to access the resources and supports ... Be responsive to requests from the billing, utilization review and administrative support staff.

Health Affiliates Maine LLC

Veterans Case Manager

Auburn, ME · On-site

$21.50 - $27.75/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Case Managers will work collaboratively with Veterans to access the resources and supports ... Be responsive to requests from the billing, utilization review and administrative support staff.

American Traveler

Travel Care Manager

Portland, ME · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Travel RN - Case Management/Utilization Review - Case Management About American Traveler With over 25 years of experience, American Traveler has established a reputation for outstanding customer ...

New

Business Integra LLC

RN Unit Manager

Falmouth, ME · On-site

$39 - $51.25/hr

Oversee utilization review processes to ensure appropriate patient care plans. * Manage case management procedures, ensuring effective treatment and follow-up. * Provide training and support to ...

UnitiMed

RN Case Manager

Biddeford, ME · On-site

  • Medical

  • Dental

  • Vision

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

New

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Utilization Review Case Manager information

See Windham, ME salary details

$16

$36

$59

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

As of Aug 14, 2026, the average hourly pay for utilization review case manager in Windham, ME is $36.33, according to ZipRecruiter salary data. Most workers in this role earn between $29.42 and $38.32 per hour, depending on experience, location, and employer.

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 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 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 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 are popular job titles related to Utilization Review Case Manager jobs in Windham, ME?

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

What job categories do people searching Utilization Review Case Manager jobs in Windham, ME look for?

The top searched job categories for Utilization Review Case Manager jobs in Windham, ME are:

What cities near Windham, ME are hiring for Utilization Review Case Manager jobs?

Cities near Windham, ME 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 Windham, ME as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $75,570 per year, or $36.3 per hour.

Drug Utilization Review (DUR) Pharmacist - Remote

Pharmacy Careers

Lewiston, ME • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Remote DUR Pharmacist - Safe & Cost-Effective Medication Use | Work From Home
Analyze medication use patterns, apply clinical guidelines, and collaborate with providers - all from home. This remote Drug Utilization Review Pharmacist role is ideal for pharmacists who enjoy clinical analysis and want to improve outcomes at scale.
Key Responsibilities

  • Conduct prospective, concurrent, and retrospective drug utilization reviews.
  • Evaluate prescribing patterns against clinical guidelines and formulary criteria.
  • Identify potential drug interactions, therapeutic duplications, and inappropriate therapy.
  • Prepare recommendations for prescribers to optimize therapy and reduce risk.
  • Document reviews and ensure compliance with state, federal, and health-plan requirements.
  • Contribute to quality-improvement initiatives and pharmacy program development.
What You'll Bring
  • Education: PharmD or Bachelor of Pharmacy.
  • Licensure: Active U.S. pharmacist license.
  • Experience: Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong clinical skills are encouraged to apply.
  • Skills: Analytical mindset, detail orientation, excellent written and verbal communication.
Why This Role?
  • Shape prescribing decisions that affect thousands of patients.
  • Build expertise in managed care and population-health pharmacy.
  • Many DUR roles offer hybrid or fully remote schedules.
  • Competitive salary, benefits, and career advancement.

About Us
We are a confidential healthcare partner providing managed-care pharmacy services nationwide. Our DUR pharmacists ensure medications are used safely, appropriately, and cost-effectively.
Apply Today
Advance your career in managed care - apply now for our Remote Drug Utilization Review Pharmacist opening.

Apply