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Utilization Review Manager Jobs in Kentucky (NOW HIRING)

Med Center Health

Insurance Specialist

Bowling Green, KY · On-site

$11.55/hr

Serves as a resource to Utilization Management by initiating the patient intake, insurance ... Review personnel. * Monitors the status of patient's insurance coverage and refers information to ...

TERRACON

Operations Manager - A/E/C Industry

Lexington, KY · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Manage and direct activities of an engineering consulting office. This includes profit/loss ... utilization of all personnel. Develop and/or review all contracts and proposals prepared by the ...

Graves Gilbert Clinic

PHARMACIST

Bowling Green, KY · On-site

$57 - $68.50/hr

The pharmacist conducts cost analyses and financial evaluations of therapies, assisting in formulary management, drug utilization review, and strategic purchasing decisions to promote both clinical ...

TERRACON

Operations Manager - A/E/C Industry

Lexington, KY

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Manage and direct activities of an engineering consulting office. This includes profit/loss ... utilization of all personnel. Develop and/or review all contracts and proposals prepared by the ...

Elevance Health

Med Mgmt Nurse

Louisville, KY · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Review experience is preferred. * Knowledge of the medical management processes and the ability to interpret and apply member contracts, member benefits, and managed care products is ...

Elevance Health

Med Mgmt Nurse

Louisville, KY · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Review experience is preferred. * Knowledge of the medical management processes and the ability to interpret and apply member contracts, member benefits, and managed care products is ...

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Showing results 41-60

All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Kentucky

Utilization Review Manager information

See Kentucky salary details

$33.9K

$79K

$145.5K

How much do utilization review manager jobs pay per year?

As of Aug 19, 2026, the average yearly pay for utilization review manager in Kentucky is $79,046.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,700.00 and $95,100.00 per year, depending on experience, location, and employer.

What does a utilization review manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.

What are the key skills and qualifications needed to thrive as a utilization review manager?

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What are some common challenges faced by utilization review managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

What is the difference between Utilization Review Manager vs Utilization Review Coordinator?

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

How much does a utilization review manager make?

A utilization review manager typically earns between $70,000 and $110,000 annually, depending on experience, location, and the size of the organization. They often require knowledge of healthcare policies, insurance processes, and may hold certifications such as URAC or CCM.

Is utilization review manager a stressful job?

Utilization review managers often work in a fast-paced healthcare environment, which can be stressful due to the need to meet strict deadlines, ensure accurate assessments, and handle complex cases. The role requires strong organizational skills and attention to detail, and some individuals may find the responsibility and workload challenging, especially during high-volume periods.

What are the most commonly searched types of Utilization Review jobs in Kentucky?

The most popular types of Utilization Review jobs in Kentucky are:

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

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

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

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

What cities in Kentucky are hiring for Utilization Review Manager jobs?

Cities in Kentucky with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Kentucky as of August 2026, with employment types broken down into 84% Full Time, 14% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $79,046 per year, or $38 per hour.

Insurance Specialist

Med Center Health

Bowling Green, KY • On-site

$11.55/hr

Part-time

Re-posted 6 days ago

Med Center Health rating

5.4

Company rating: 5.4 out of 10

Based on 25 frontline employees who took The Breakroom Quiz

Job description

  • Position Summary
    • Serves as a resource to Utilization Management by initiating the patient intake, insurance verification and authorization processes to ensure that care is provided in the correct setting with proper authorization and in compliance with regulatory and insurance standards. Maintains knowledge of Center Care contracts and other managed care insurance contracts. Initiates Pre-Certifications and obtains benefit information for inpatient and observation admissions.
  • Minimum Qualifications
    • Work Experience
      • Previous hospital and/or insurance verification or billing experience preferred.
    • Education
      • Associate's degree preferred.
    • Certifications/Licensure
      • None required.
  • Job Specific Performance Standards
    • The duties listed below are a summary of the major essential functions of this position. The position may require other duties, both major and minor, that are not mentioned, and specific functions may change from time to time.
      • Verifies insurance and contacts insurance companies via phone and/or online insurance payer portals to notify for pre-certifications for inpatient and observation admissions. Verifies and assigns appropriate insurance mnemonics and information obtained into Meditech for use by Utilization Review personnel.
      • Monitors the status of patient's insurance coverage and refers information to Financial Counselor as necessary. Thoroughly documents information obtained from insurance representatives into Meditech.
      • Researches questionable insurance coverage and promptly communicates any identified problems to appropriate personnel for follow up.
      • Monitors insurance mnemonics for accuracy, maintains spreadsheet of registration mnemonic issues and communicates with Registration Director for process improvements.
      • Establishes and maintains positive working relationships with Utilization Management staff and Physician offices/clinics. Identifies opportunities for service optimization and works to act upon opportunities. Contacts physician Offices/clinics to resolve issues regarding insurance verification and prior authorization.
      • Collaborates with Patient Financial Services, Patient Registration, Utilization Management, and Center Care to ensure that Med Center Health is aware of and operates in accordance with insurance front-end requirements. Notifies of any updates regarding insurance information and managed care contracts.

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