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Utilization Review Manager Jobs in Ohio (NOW HIRING)

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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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What job categories do people searching Utilization Review Manager jobs in Ohio look for? The top searched job categories for Utilization Review Manager jobs in Ohio are:
What cities in Ohio are hiring for Utilization Review Manager jobs? Cities in Ohio with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you
Utilization Review Coordinator

Utilization Review Coordinator

Neuropsychiatric Hospitals

Huber Heights, OH • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 12 days ago

Job description

About Us
Healing Body and Mind.
NeuroPsychiatric Hospitals is a national leader in behavioral healthcare, specializing in patients with acute psychiatric and complex medical needs. Our hospitals use an interdisciplinary, multi-specialty approach that delivers high-quality, patient-centered care when it's needed most.
With locations in Indiana, Michigan, Texas, and Arizona, we're expanding access to our unique model of care across the United States. Join us and be part of a team dedicated to making a lasting difference in the lives of patients and families every day
Overview
North Valley Behavioral Hospital, a brand new psychiatric hospital within the NeuroPsychiatric Hospitals network, is looking for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams.
Benefits of joining NPH
  • Competitive pay rates
  • Medical, Dental, and Vision Insurance
  • NPH 401(k) plan with up to 4% Company match
  • Employee Assistance Program (EAP) Programs
  • Generous PTO and Time Off Policy
  • Special tuition offers through Capella University
  • Work/life balance with great professional growth opportunities
  • Employee Discounts through LifeMart

Responsibilities
  • Filing documents as needed.
  • Initial Precertification with payors.
  • Concurrent Clinical review with payors.
  • Document in the electronic system daily in real time.
  • Admission audit.
  • Ensures that CON's/RON's and CMS certifications are completed by provider.
  • Consistently demonstrates professionalism with all internal and external customers as evidenced by positive customer and peer Communicates effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships.
  • Maintains knowledge of current trends and developments in the field by reading appropriate books; journals and other literature and attending related seminars or conferences.
  • Maintains a professional approach with Assures protection and privacy of health information as attained through written, electronic or oral disclosures.
  • Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
  • Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as hospital polices that apply.
  • Complies with hospital expectations regarding ethical behavior and standards of conduct.
  • Complies with federal and hospital requirements in the areas of protected health information and patient information.
  • Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes to the VP of Care Management and Team.
  • Provides education to nursing staff. leadership team, and providers regarding documentation.
  • Actively works with the business office regarding resolution of appeals/denials and retrospective reviews.

Qualifications
Education: Bachelor's in Behavioral Health, Social Work, Counseling, Nursing or Psychology required. Master's degree preferred.
Experience: Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 years of case management experience, including discharge planning in a hospital setting required.
Licensure: Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred. Basic Life Support (BLS) and Handle with Care (HWC) obtained during orientation, if applicable.
Skills: Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills. Must be detail oriented.#INDEEDLOW

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