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Utilization Review Manager information

See Ohio salary details

$37.1K

$86.5K

$159.2K

How much do utilization review manager jobs pay per year?

As of Jul 17, 2026, the average yearly pay for utilization review manager in Ohio is $86,524.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,600.00 and $104,100.00 per year, depending on experience, location, and employer.

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, and why are they important?

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?

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.

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 Ohio? The most popular types of Utilization Review jobs in Ohio are:
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Utilization Review Manager jobs near you
Utilization Review Support Specialist-2

Utilization Review Support Specialist-2

Nationwide Children's Hospital

Columbus, OH • On-site

Full-time

This job post has expired today. Applications are no longer accepted.

Nationwide Children's Hospital rating

6.9

Company rating: 6.9 out of 10

Based on 129 frontline employees who took The Breakroom Quiz

534th of 1,020 rated hospitals

Job description

Overview:


Schedule: M-F (Day Shift)


Job Description Summary:


Provides administrative support to the Utilization Review Team and assists with eligibility verification, data entry, and coordination of information.


Job Description:


Essential Functions:

  • Coordinates with external healthcare providers, payors, patients, and internal teams to obtain and provide necessary account information.
  • Serves as a liaison for inquiries and issues regarding authorizations, denials, and utilization reviews.
  • Manages incoming and outgoing telephones, emails, and faxes. Monitors and completes multiple work queues.
  • Maintains accurate and complete documentation of admission authorizations and other utilization review information.
  • Reports utilization review progress to leadership and ensures compliance with contractual standards and regulations.
  • Participates in quality improvement initiatives to enhance utilization review processes.


Education Requirement:

  • High School Diploma or equivalent, required.
  • Associate's Degree, preferred.


Licensure Requirement:

(not specified)


Certifications:

(not specified)


Skills:

Working knowledge of medical terminology, general medical office procedures, and HIPAA regulations.


Experience:

  • One year of experience in hospital setting or medical office, required.
  • Experience with CPT, ICD-10 and HCPCS coding, preferred.
  • Two years of managed care experience including experience in a call center, preferred.


Physical Requirements:

OCCASIONALLY: Lifting / Carrying: 0-10 lbs, Lifting / Carrying: 11-20 lbs, Machinery, Pushing / Pulling: 0-25 lbs, Standing

FREQUENTLY: Color vision, Flexing/extending of neck, Interpreting Data, Reaching above shoulder, Repetitive hand/arm use, Walking

CONTINUOUSLY: Audible speech, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Peripheral vision, Problem solving, Seeing - Far/near, Sitting


Additional Physical Requirements performed but not listed above:

Talking on the phone/in person Constantly




"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"

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About Nationwide Children's Hospital

Sourced by ZipRecruiter

Nationwide Children's Hospital, established in 1894, is a leading pediatric healthcare system based in Columbus, Ohio, United States. They serve as a primary pediatric network, providing wellness, preventive, diagnostic, treatment, and rehabilitative care for infants, children, adolescents, and adults with congenital disease. Being the third-largest pediatric hospital in the nation, Nationwide Children's Hospital prides itself on its relentless commitment to children and their families, driven by their core values of respect, integrity, determination, empathy, and solidarity. The institution's comprehensive mission is to enhance the health of children by providing high-quality, family-centered care, conducting groundbreaking research, advocating for pediatric health, and training top healthcare professionals.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Columbus, OH, US

Year founded

1892

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