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Utilization Review Manager Jobs in New York (NOW HIRING)

CareConnect

Utilization Review RN

Greenvale, NY · On-site

Reviews and coordinates prospective, concurrent and retrospective activities related to utilization ... Provides timely and thorough case screening to identify case management needs and make appropriate ...

CareConnect

Utilization Review RN

Greenvale, NY

Reviews and coordinates prospective, concurrent and retrospective activities related to utilization ... Provides timely and thorough case screening to identify case management needs and make appropriate ...

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Utilization Review Manager information

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$42.7K

$99.6K

$183.3K

How much do utilization review manager jobs pay per year?

As of Aug 18, 2026, the average yearly pay for utilization review manager in New York is $99,569.00, according to ZipRecruiter salary data. Most workers in this role earn between $65,100.00 and $119,800.00 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 New York?

The most popular types of Utilization Review jobs in New York are:

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

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

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

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

What cities in New York are hiring for Utilization Review Manager jobs?

Cities in New York with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in New York as of August 2026, with employment types broken down into 86% Full Time, 13% Part Time, and 1% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $99,569 per year, or $47.9 per hour.

Project Manager, Utilization Review

Med-Metrix

Parsippany, NJ • On-site

$100K - $125K/yr

Full-time

Posted 5 days ago

Med-Metrix rating

6.9

Company rating: 6.9 out of 10

Based on 21 frontline employees who took The Breakroom Quiz

283rd of 492 rated business services

Job description

Job Purpose
The Project Manager, Utilization Review provides operational and analytical support to Physician Advisory end-to-end clients. The Project Manager, Utilization Review will oversee implementation coordination, stakeholder management, utilization data analysis
Duties & Responsibilities
  • Prepare and participate in client review meetings (decks, data summaries, presentations)
  • Track deliverables, timelines, and client escalations
  • Support client onboarding processes and operational handoffs
  • Analyze utilization data, case trends, and client performance metrics
  • Investigate clinical and operational issues for end-to-end clients
  • Prepare data-driven summaries and recommendations for leadership review
  • Participate in evaluation of hospital UR processes and application of screening tools (MCG, IQ)
  • Support reporting infrastructure and PowerBI data validation
  • Lead ad-hoc projects for end-to-end clients as directed
  • Provide support on time-sensitive deliverables and client requests
  • Manage project timelines, resources, and stakeholder coordination
  • Serve as operational point of contact for end-to-end clients
  • Support escalation resolution and issue tracking
  • Contribute to operational efficiency improvements
  • Other duties as assigned
  • Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Understand and comply with Information Security and HIPAA policies and procedures at all times
  • Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications
  • Active RN license required
  • Utilization Review experience (required)
  • 4+ years Healthcare compliance and utilization review experience required
  • 3+ Project management experience required; PM certification a plus
  • Proficiency with data analysis tools and MCG and IQ application expertise required
  • End-to-end client or managed care operations experience
  • PowerBI or data visualization experience preferred
  • Proficiency in Microsoft Office Suite
  • Strong interpersonal skills, ability to communicate well at all levels of the organization
  • Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
  • High level of integrity and dependability with a strong sense of urgency and results oriented
  • Excellent written and verbal communication skills required

Working Conditions
  • Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes
  • Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear
  • Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress
  • Work Environment: The noise level in the work environment is usually minimal

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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