UTILIZATION SPECIALIST
Hudson, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
North Olmsted, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
North Olmsted, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
Organizes and manages the activties of the Utilization Review department specifically focusing on clinical utilization reviews, timeliness, accuracy, and denial prevention. Oversees the application ...
Organizes and manages the activties of the Utilization Review department specifically focusing on clinical utilization reviews, timeliness, accuracy, and denial prevention. Oversees the application ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Brunswick, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Brunswick, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Brook Park, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Brook Park, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Berea, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Berea, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Parma, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Parma, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...
Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...
Utilization Review Manager information
See Ohio salary details
$37.1K - $48.2K
9% of jobs
$56.4K is the 25th percentile. Wages below this are outliers.
$48.2K - $59.3K
22% of jobs
$59.3K - $70.4K
11% of jobs
The median wage is $77.2K / yr.
$70.4K - $81.5K
14% of jobs
$81.5K - $92.6K
12% of jobs
$99.5K is the 75th percentile. Wages above this are outliers.
$92.6K - $103.7K
13% of jobs
$103.7K - $114.8K
13% of jobs
$114.8K - $125.9K
5% of jobs
$125.9K - $137K
2% of jobs
$137K - $148.1K
0% of jobs
$148.1K - $159.2K
0% of jobs
$37.1K
$86.5K
$159.2K
How much do utilization review manager jobs pay per year?
As of Aug 14, 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.
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 Ohio?
The most popular types of Utilization Review jobs in Ohio are:
What are popular job titles related to Utilization Review Manager jobs in Ohio?
For Utilization Review Manager jobs in Ohio, the most frequently searched job titles are:
- Freelance Utilization Review Nurse
- Evening Optum Health Utilization Review
- Evening Utilization Review Nurse
- Remote Utilization Review Nurse
- Night Shift Remote Utilization Review Nurse
- Utilization Review Nurse
- Utilization Review Physician
- No Experience Utilization Management Nurse
- No Experience Utilization Review Nurse
- Night Utilization Review Nurse
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:
- Behavioral Utilization Review
- Remote Weekend Utilization Review
- Manager Aetna Utilization Review
- Remote Navihealth Utilization Review
- Milliman
- Freelance International Utilization Review Nurse
- Remote Dental Utilization Review
- Aetna Utilization Review Nurse
- Remote Aetna Utilization Review
- Remote Optum Utilization Review
What cities in Ohio are hiring for Utilization Review Manager jobs?
Cities in Ohio with the most Utilization Review Manager job openings:
Southwest General Health Center rating
6.9
Based on 46 frontline employees who took The Breakroom Quiz
552nd of 1,059 rated hospitals
Job description
Summary
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POSITION INFORMATION
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Position summary:
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The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital resources, and quality of care rendered. Accurate and efficient application of screening criteria will be applied to identify and support patients being placed in the appropriate hospital level of care via emergency, scheduled, or direct admission processes. Combines clinical, business, and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification, and education, the Utilization Specialist facilitates the quality of health care delivery in the most cost-effective manner. The Utilization Specialist must be able to demonstrate the knowledge and skills necessary to provide services appropriate to age groups according to specific chronological age, developmental age, and/or psycho-social maturity. The Utilization Specialist will work collaboratively with management, staff, and departments involved in the patients plan of care. The Utilization Specialists responsibility is to collect data and clinical review summaries on patients concurrently for both utilization review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The Utilization Specialist will communicate with physicians, hospital staff, outside agencies such as insurance companies, and patients regarding the assigned level of care and associated resource utilization.
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MINIMUM QUALIFICATIONS
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Education:
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Graduation from an accredited School of Nursing. BSN graduate preferred.
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Required length and type of experience:-
Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management)
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Previous Care Management, Case Management or Utilization Management Experience preferred
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Previous experience with screening criteria (i.e. Interqual, MCG) preferred
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Excellent critical thinking and communication skills
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Strong computer skills
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Required licensure, certification or registry:-
Current licensure by Ohio State Board of Nursing.
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ACM/CCM Certification helpful
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What Southwest General Health Center employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Southwest General
Sourced by ZipRecruiter
Industry
Hospitals
Company size
1,001 - 5,000 Employees
Headquarters location
Middleburg Heights, OH, US
Year founded
1920