Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Utilization Review Manager information
See Nevada salary details
$39.7K - $51.6K
9% of jobs
$60.4K is the 25th percentile. Wages below this are outliers.
$51.6K - $63.5K
22% of jobs
$63.5K - $75.4K
11% of jobs
The median wage is $82.7K / yr.
$75.4K - $87.3K
14% of jobs
$87.3K - $99.2K
12% of jobs
$106.6K is the 75th percentile. Wages above this are outliers.
$99.2K - $111.1K
13% of jobs
$111.1K - $123K
13% of jobs
$123K - $134.9K
5% of jobs
$134.9K - $146.8K
2% of jobs
$146.8K - $158.7K
0% of jobs
$158.7K - $170.6K
0% of jobs
$39.7K
$92.7K
$170.6K
How much do utilization review manager jobs pay per year?
As of Aug 12, 2026, the average yearly pay for utilization review manager in Nevada is $92,677.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,600.00 and $111,500.00 per year, depending on experience, location, and employer.
Is utilization review a stressful job?
Utilization review managers oversee the assessment of healthcare services to ensure appropriate and efficient care, which can involve high workloads and strict deadlines, leading to stress. The job requires strong organizational skills, attention to detail, and the ability to handle complex cases, which may contribute to job-related stress for some individuals.
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 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 is the difference between Utilization Review Manager vs Utilization Review Coordinator?
| Aspect | Utilization Review Manager | Utilization Review Coordinator |
|---|---|---|
| Certifications | Typically requires certifications like CCM or ACU | May require similar certifications but often less advanced |
| Work Environment | Supervises review teams, manages processes in healthcare or insurance settings | Performs case reviews, supports the review process under supervision |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Insurance 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.
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 most commonly searched types of Utilization Review jobs in Nevada? The most popular types of Utilization Review jobs in Nevada are:
What are popular job titles related to Utilization Review Manager jobs in Nevada? For Utilization Review Manager jobs in Nevada, the most frequently searched job titles are:
- Contract Utilization Review Nurse
- Utilization Review Nurse
- Remote Utilization Review Rn
- Remote Utilization Review Nurse
- Utilization Management Nurse
- Flexible Cvs Utilization Management Nurse
- Freelance Utilization Review Nurse
- Cvs Health Utilization Management Remote
- Overnight Utilization Review Nurse
- Part Time Utilization Review Nurse
What job categories do people searching Utilization Review Manager jobs in Nevada look for? The top searched job categories for Utilization Review Manager jobs in Nevada are:
- Authorization Utilization Review Bcba
- Part Time Utilization Review
- Freelance International Utilization Review Nurse
- Weekend Utilization Review
- Optum Utilization Review Nurse
- Case Manager Utilization Review Nurse
- Utilization Review Nurse Compact License
- Remote International Utilization Review Nurse
- Director Of Utilization Review
- Remote Optum Utilization Review
What cities in Nevada are hiring for Utilization Review Manager jobs? Cities in Nevada with the most Utilization Review Manager job openings:
Job description
Overview
PURPOSE STATEMENT:Â
Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Â
ResponsibilitiesESSENTIAL FUNCTIONS:Â
- Act as liaison between managed care organizations and the facility professional clinical staff.Â
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.Â
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay. Â
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.Â
- Conduct quality reviews for medical necessity and services provided. Â
- Facilitate peer review calls between facility and external organizations. Â
- Initiate and complete the formal appeal process for denied admissions or continued stay. Â
- Assist the admissions department with pre-certifications of care. Â
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.Â
OTHER FUNCTIONS: Â
- Perform other functions and tasks as assigned.Â
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:Â
- Required Education: High school diploma or equivalent.Â
- Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.Â
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferredÂ
LICENSES/DESIGNATIONS/CERTIFICATIONS: Â
- Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.Â
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility. Â
- First aid may be required based on state or facility requirements.Â
Â
ADDITIONAL REGULATORY REQUIREMENTS:Â
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances  (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.Â
We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.
Employment Type: FULL_TIME
About SEVEN HILLS HOSPITAL
Sourced by ZipRecruiter
Company size
11 - 50 Employees
Headquarters location
Henderson, NV, US
Year founded
2008