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Utilization Review Manager Jobs in West Virginia

Dane Street

Board-Certified Neurologist

Chapmanville, WV · On-site

$284K - $355K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

Dane Street, LLC

Board-Certified Neurologist

Chapmanville, WV · On-site

$284K - $355K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

Dane Street, LLC

Board-Certified Neurologist

Chapmanville, WV · On-site

$284K - $355K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

Encova Insurance

Nurse Case Manager

Charleston, WV · On-site

$55K - $110K/yr

The position's objective is to provide high quality customer service in workers' compensation medical case management and utilization review, primarily telephonically. The Nurse Case Manager provides ...

Encova Insurance

Nurse Case Manager

Charleston, WV · On-site +1

$55K - $110K/yr

The position's objective is to provide high quality customer service in workers' compensation medical case management and utilization review, primarily telephonically.The Nurse Case Manager provides ...

Encova Insurance

Nurse Case Manager

Charleston, WV · On-site

$55K - $110K/yr

The position's objective is to provide high quality customer service in workers' compensation medical case management and utilization review, primarily telephonically.The Nurse Case Manager provides ...

Care Career

Travel RN UM - $2,200 per week

Marlinton, WV · On-site

$2.2K/wk

Care Career is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Marlinton, West Virginia. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...

Encova Insurance

Nurse Case Manager

Charleston, WV · On-site

$55K - $110K/yr

The position's objective is to provide high quality customer service in workers' compensation medical case management and utilization review, primarily telephonically. The Nurse Case Manager provides ...

WVU Medicine

RN-ACT

Clarksburg, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care ... Provides group therapy as deemed appropriate by the psychiatrist and Manager. 18. Establishes and ...

WVU Medicine

RN-ACT

Morgantown, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care ... Provides group therapy as deemed appropriate by the psychiatrist and Manager. 18. Establishes and ...

WVU Medicine

RN-ACT

Morgantown, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care ... Provides group therapy as deemed appropriate by the psychiatrist and Manager. 18. Establishes and ...

WVU Medicine

RN-ACT

Clarksburg, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care ... Provides group therapy as deemed appropriate by the psychiatrist and Manager. 18. Establishes and ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in West Virginia

Utilization Review Manager information

See West Virginia salary details

$30.2K

$70.5K

$129.7K

How much do utilization review manager jobs pay per year?

As of Aug 27, 2026, the average yearly pay for utilization review manager in West Virginia is $70,458.00, according to ZipRecruiter salary data. Most workers in this role earn between $46,100.00 and $84,800.00 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 West Virginia?

The most popular types of Utilization Review jobs in West Virginia are:

What are popular job titles related to Utilization Review Manager jobs in West Virginia?

For Utilization Review Manager jobs in West Virginia, the most frequently searched job titles are:

What job categories do people searching Utilization Review Manager jobs in West Virginia look for?

The top searched job categories for Utilization Review Manager jobs in West Virginia are:

What cities in West Virginia are hiring for Utilization Review Manager jobs?

Cities in West Virginia with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in West Virginia as of August 2026, with employment types broken down into 85% Full Time, 14% Part Time, and 1% Contract. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $70,458 per year, or $33.9 per hour.

Utilization Assistant - Acute

Charleston, WV • On-site

Summit BHC
Health Care and Social Assistance • 501 - 1,000 employees
Learn more about Summit BHCexternal

Full-time

Posted 15 days ago

Job description

Utilization Assistant - Acute | Highland Hospital | Charleston, West Virginia
About the Job:
The Utilization Assistant provides support to all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information. Works with insurance providers to obtain coverage for patients. Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources.
Roles and Responsibilities:
• Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.
• Reviews medical records of patients for appropriateness of level of care at admission and at intervals determined by documentation in medical record.
• Conducts interactive and timely reviews with payers to ensure certification of care.
• Maintains accurate documentation and files as it relates to utilization management.
• Coordinates information and findings with the business office to help recognize or resolve possible payment problems.
• Attends daily treatment team to discuss patient needs and ensure that all disciplines are aware of patient insurance status and needs.
• Ensure that insurance benefits are verified in a timely manner.
• Communicates any UR or Quality issues as noted in the chart to supervisor immediately to ensure timely resolution of problems.
• Responds to telephone and Internet inquires.
• Researches insurance company guidelines and uses admission and continuing stay criteria for coverage.
• High School Diploma Required, Bachelor's Degree in social work, behavioral or mental health, or other related health field preferred.
• One or more years of direct clinical experience in a psychiatric or mental health setting preferred.
Why Highland Hospital?Highland Hospital offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Highland Hospital is an EOE.
Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.
Summit BHC logo

About Summit BHC

Sourced by ZipRecruiter

Summit BHC, based in Franklin, TN, USA, is a recognized leader in the field of addiction treatment and behavioral health care services. The company operates a nationwide network of treatment centers aimed at caring for individuals battling substance abuse and mental health disorders. Summit BHC was established with the mission to provide high-quality, addiction treatment and behavioral health services to those in need throughout the United States. With compassion, dignity, and respect as their core values, they endeavor to instill hope during the journey to recovery and beyond.

Industry

Health care and social assistance

Company size

501 - 1,000 Employees

Headquarters location

Franklin, TN, US

Year founded

2013

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