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Utilization Review Management Jobs in Ohio (NOW HIRING)

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Utilization Review Management information

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How much do utilization review management jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for utilization review management in Ohio is $30.37, according to ZipRecruiter salary data. Most workers in this role earn between $21.25 and $38.61 per hour, depending on experience, location, and employer.

What are the job titles for utilization review management?

Job titles in utilization review management include Utilization Review Nurse, Utilization Review Coordinator, Utilization Review Nurse Case Manager, and Utilization Review Supervisor. These roles typically involve assessing medical necessity, reviewing patient records, and ensuring compliance with healthcare policies, often requiring certification such as the Certified Professional in Healthcare Quality (CPHQ).

What is the difference between Utilization Review Management vs Utilization Review Nurse?

AspectUtilization Review ManagementUtilization Review Nurse
CredentialsTypically requires a healthcare management or related certification, sometimes a nursing backgroundRegistered Nurse (RN) license, often with additional utilization review certification
Work EnvironmentOffice-based, administrative setting, collaborating with healthcare providers and insurance companiesClinical setting, reviewing patient charts, and making utilization decisions
Employer & IndustryHealth insurance companies, managed care organizations, healthcare administratorsHospitals, insurance companies, healthcare facilities

Utilization Review Management professionals focus on overseeing review processes, policy compliance, and administrative tasks, while Utilization Review Nurses conduct clinical assessments to determine appropriate care. Both roles are essential in healthcare utilization management but differ in responsibilities and work environment.

What are some common challenges faced by professionals in utilization review management, and how can they be addressed?

Professionals in Utilization Review Management often encounter challenges such as balancing regulatory compliance with patient advocacy and managing high caseloads under tight deadlines. Navigating complex insurance policies and ensuring timely communication between healthcare providers and payers can be demanding. Staying organized, leveraging technology for workflow management, and participating in ongoing training can help address these challenges. Additionally, strong collaboration with interdisciplinary teams ensures more effective and efficient utilization review processes.

What is utilization review management?

Utilization Review Management is a process used in healthcare to evaluate the necessity, appropriateness, and efficiency of medical services, procedures, and facilities. Its primary goal is to ensure that patients receive appropriate care while preventing unnecessary or duplicative services. Utilization Review Management helps healthcare providers and insurance companies manage costs, maintain high-quality care, and comply with regulations. Professionals in this field often review patient records, coordinate with clinicians, and make recommendations about coverage or care plans.

What are the key skills and qualifications needed to thrive in utilization review management?

To thrive in Utilization Review Management, you need a solid background in healthcare, strong analytical skills, and often a clinical degree such as RN or LPN, with certification in utilization review or case management being highly beneficial. Familiarity with medical coding systems (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required. Excellent communication, critical thinking, and negotiation skills help you collaborate with providers and payers while advocating for patient care. These competencies are vital for ensuring appropriate resource use, regulatory compliance, and optimal patient outcomes.
Utilization Review Management jobs near you
Infographic showing various Utilization Review Management job openings in Ohio as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 11% Part Time, and 5% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $63,160 per year, or $30.4 per hour.

RN UTILIZATION SPECIALIST - DENIALS & APPEALS

Southwest General

Middleburg Heights, OH • On-site

Full-time

Re-posted 10 days ago

Southwest General Health Center rating

6.9

Company rating: 6.9 out of 10

Based on 46 frontline employees who took The Breakroom Quiz

553rd of 1,058 rated hospitals

Job description

  • POSITION INFORMATION
    • Position summary: Utilization Specialist - Denials & Appeals will support the clinical staff, utilization specialists, denials management, and the Physician Advisors. This role will review patient medical records to ensure accurate documentation, proper level of care, and compliance with regulatory standards to prevent denials in the acute care setting.
  • MINIMUM QUALIFICATIONS
    • Education:
      • Bachelor's degree in nursing (BSN) preferred
    • Required length and type of experience:
      • Minimum of three years of clinical nursing experience, with strong preference for experience in case management, utilization review, or CDI, in the acute care setting.
      • Knowledge of ICD-10 coding guidelines, Medicare/Medicaid regulations, MCG, Cerner (EMR), MS office tools, such as Word, Excel, PowerPoint.
      • Ability to analyze complex medical records and identify gaps in documentation.
      • Strong verbal and written communication skills to interact with physicians and insurance payers.
      • Ability to collaborate with diverse teams including nurses, physicians, and administrative staff.
    • Required licensure, certification or registry:
      • Current RN License by the Ohio State Board of Nursing.
      • Preferred certification(s): ACM/ACM-RN, CCM, CMAC, CPHQ.

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