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Utilization Review Manager Jobs in Mississippi (NOW HIRING)

UHS

Director of Utilization Review

Gulfport, MS · On-site

Minimum of 2 years clinical experience and 1 year of management experience with case management and the utilization review process including concurrent reviews. Previous continuum of care experience ...

UHS

Director of Utilization Review

Gulfport, MS · On-site

Minimum of 2 years clinical experience and 1 year of management experience with case management and the utilization review process including concurrent reviews. Previous continuum of care experience ...

UHS

Director of Utilization Review

Gulfport, MS · On-site

Minimum of 2 years clinical experience and 1 year of management experience with case management and the utilization review process including concurrent reviews. Previous continuum of care experience ...

UHS

Director of Utilization Review

Gulfport, MS · On-site

Minimum of 2 years clinical experience and 1 year of management experience with case management and the utilization review process including concurrent reviews. Previous continuum of care experience ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Mississippi

Utilization Review Manager information

See Mississippi salary details

$36.9K

$86.2K

$158.6K

How much do utilization review manager jobs pay per year?

As of Sep 4, 2026, the average yearly pay for utilization review manager in Mississippi is $86,194.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,400.00 and $103,700.00 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 Mississippi?

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

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

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

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

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

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

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

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Mississippi as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $86,194 per year, or $41.4 per hour.

Utilization Review Specialist

ADDICTION AND MENTAL HEALTH SERVICES, LLC

Lucedale, MS • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Key responsibilities

  • Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services.

  • Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details.

  • Make informed decisions regarding authorization, continuation, or denial of services based on clinical guidelines, policies, and regulatory requirements.

Job description

About Company:

We’re officially a Great Place To Work®! We’ve always believed that supporting our team is just as important as supporting our patients. Now, we’re proud to share that we’ve earned Great Place To Work® Certification - based entirely on feedback from our own employees.

Read more here: https://ow.ly/YQ1C50WuRH1

This certification reflects the culture we’ve worked hard to build - one rooted in trust, inclusion, and purpose-driven leadership.

At Bradford Health Services, we are committed to providing exceptional care to our patients while fostering a supportive and rewarding workplace for our employees. We believe that taking care of our team allows them to take better care of others, which is why we offer a comprehensive benefits package designed to support their well-being.

Our benefits include:

  • Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits.

  • Expanded Coverage – Options for domestic partners and a wider network of in-network providers.

  • Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching.

  • Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more.

  • Student Loan Repayment – Available for nurses and therapists.

  • Retirement Benefits – 401(k) plan through Voya to help employees plan for the future.

  • Generous PTO – A robust paid time off policy to support work-life balance.

  • Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.

At Bradford Health Services, we don’t just invest in our patients—we invest in our people.



About the Role:

The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of patient records, treatment plans, and clinical data to determine the appropriateness of care and resource utilization. The specialist collaborates closely with healthcare providers, insurance companies, and case managers to facilitate timely approvals and optimize patient outcomes. By applying clinical knowledge and analytical skills, the role helps to control healthcare costs while maintaining high-quality patient care. Ultimately, the Utilization Review Specialist contributes to the integrity and sustainability of healthcare delivery systems across the United States.

Minimum Qualifications:

  • Bachelor’s degree in Nursing, Health Administration, or a related healthcare field.
  • At least 2 years of experience in utilization review, case management, or clinical healthcare roles.
  • Strong knowledge of medical terminology, clinical procedures, and healthcare regulations.
  • Familiarity with insurance authorization processes and utilization management guidelines.
  • Excellent communication and analytical skills with attention to detail.

Preferred Qualifications:

  • Registered Nurse (RN) license or relevant clinical certification.
  • Experience working with electronic health record (EHR) systems and utilization review software.
  • Certification in Utilization Review (e.g., Certified Professional in Utilization Review or Certified Case Manager).
  • Knowledge of specific payer policies and healthcare reimbursement models.
  • Advanced training in healthcare compliance and quality assurance.

Responsibilities:

  • Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services.
  • Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details.
  • Make informed decisions regarding authorization, continuation, or denial of services based on clinical guidelines, policies, and regulatory requirements.
  • Document findings and decisions accurately in electronic health record systems and prepare detailed reports for internal and external stakeholders.
  • Stay current with healthcare regulations, insurance policies, and clinical best practices to ensure compliance and effective utilization management.

Skills:

The Utilization Review Specialist uses clinical expertise and analytical skills daily to evaluate patient care plans and determine medical necessity. Strong communication skills are essential for collaborating effectively with healthcare providers and insurance representatives to gather information and explain decisions. Attention to detail ensures accurate documentation and compliance with regulatory standards. Proficiency with electronic health records and utilization management software facilitates efficient case review and reporting. Additionally, staying informed about healthcare policies and clinical guidelines enables the specialist to make well-informed, ethical decisions that balance patient care quality with cost containment.

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