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Utilization Review Manager Jobs in Tennessee (NOW HIRING)

UHS

Utilization Review Coordinator

Mountain City, TN · On-site

Utilization Review Coordinator Position Summary Mountain Youth Academy is nestled in Mountain City ... Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and ...

UHS

Utilization Review Coordinator

Mountain City, TN · On-site

Utilization Review Coordinator Position Summary Mountain Youth Academy is nestled in Mountain City ... Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and ...

UHS

Utilization Review Coordinator

Mountain City, TN · On-site

Utilization Review Coordinator Position Summary Mountain Youth Academy is nestled in Mountain City ... Maintain utilization management databases and spreadsheets. * Prepare weekly, monthly, and ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Tennessee

Utilization Review Manager information

See Tennessee salary details

$35.4K

$82.6K

$152K

How much do utilization review manager jobs pay per year?

As of Jul 27, 2026, the average yearly pay for utilization review manager in Tennessee is $82,603.00, according to ZipRecruiter salary data. Most workers in this role earn between $54,000.00 and $99,400.00 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 Tennessee? The most popular types of Utilization Review jobs in Tennessee are:
What are popular job titles related to Utilization Review Manager jobs in Tennessee? For Utilization Review Manager jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Tennessee look for? The top searched job categories for Utilization Review Manager jobs in Tennessee are:
What cities in Tennessee are hiring for Utilization Review Manager jobs? Cities in Tennessee with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Tennessee as of July 2026, with employment types broken down into 100% Full Time. Highlights an 90% In-person, and 10% Remote job distribution, with an average salary of $82,603 per year, or $39.7 per hour.
Manager, Utilization Review (5052)

Manager, Utilization Review (5052)

REGIONAL ONE HEALTH

Memphis, TN • On-site

Full-time

Posted 15 days ago

Regional One Health rating

6.4

Company rating: 6.4 out of 10

Based on 36 frontline employees who took The Breakroom Quiz

644th of 890 rated healthcare providers

Job description

Regional One Health is currently seeking a Manager, Utilization Review

A Brief Overview
The Manager, Utilization Review manages the daily operations of the Utilization Review Department and is responsible for overseeing and coordinating utilization review processes within Regional One Health. Utilization Review activities include inpatient, observation, outpatient in a bed, ambulatory surgery, and Point-of-Entry Utilization review/case management activities. This role is crucial in ensuring appropriate utilization of healthcare resources while maintaining high-quality patient care. The Utilization Review Manager works collaboratively with medical and hospital staff to efficiently support and integrate utilization review activities.
What you will do

  • Reports to the Sr. Director on department activities, market changes, and operational opportunities, presenting action plans as necessary.
  • Establishes and maintains an organizational structure and staffing to meet departmental and organizational goals.
  • Develops and implements utilization review policies and procedures in compliance with regulatory requirements and industry best practices.
  • Stay current on changes in healthcare regulations, laws, and policies affecting utilization review.
  • Supervises the utilization review staff, including case managers (Point of Entry) and the utilization review team.
  • Oversees the submission of utilization activities, including ensuring timely and accurate submission of medical necessity reviews, clinical documentation to providers for authorization and concurrent review, and planned surgery authorizations.
  • Conducts periodic reviews of medical records to assess the appropriateness of care and services provided.
  • Assists in developing and managing department budgets and implementing cost containment measures as needed.
  • Participates in quality improvement initiatives, including patient satisfaction surveys and process improvement projects.
  • Communicates utilization review findings and recommendations to hospital administration, medical staff, and other stakeholders.
  • Ensures compliance with best practices and standards related to utilization review metrics and data collection.
  • Oversees staff competencies, training, and development to maintain a highly skilled workforce.
  • Supports leadership in setting department goals, monitoring program effectiveness, and making necessary adjustments based on utilization statistics and cost-benefit analysis.
  • Leads quality improvement initiatives, including audits and mock inspections, to maintain compliance and operational excellence.
  • Ensures timely submission of departmental reports, highlighting findings, recommendations, and action plans.
  • Encourages professional growth and continuous education among team members.
  • Bachelor's Degree in Healthcare Administration or Management Preferred
  • Bachelor's Degree in Nursing (BSN) Preferred
  • Master's Degree Strongly preferred
  • Registered Nurse (RN) Required
  • Minimum 5 years experience Five (5) years’ progressively responsible related experience is required, preferably within a healthcare environment. Required


Physical Demands

  • Standing - Occasionally
  • Walking - Occasionally
  • Sitting - Constantly
  • Lifting - Rarely
  • Carrying - Rarely
  • Pushing - Rarely
  • Pulling - Rarely
  • Climbing - Rarely
  • Balancing - Rarely
  • Stooping - Rarely
  • Kneeling - Rarely
  • Crouching - Rarely
  • Crawling - Rarely
  • Reaching - Rarely
  • Handling - Occasionally
  • Grasping - Occasionally
  • Feeling - Rarely
  • Talking - Constantly
  • Hearing - Constantly
  • Repetitive Motions - Frequently
  • Eye/Hand/Foot Coordination - Frequently


Regional One Health is an equal opportunity employer.

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