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Utilization Review Manager Jobs in Cleveland, TN

Encompass Health

Case Manager

Chattanooga, TN · On-site

$18.25 - $23.50/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Case Manager

Cleveland, TN · On-site

$16.75 - $21.50/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health Corporation

Case Manager

Cleveland, TN · On-site

$16.50 - $21.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health Corporation

Case Manager

Chattanooga, TN · On-site

$18.25 - $23.50/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Aldridge Pite LLP

Title Reviewer

Chattanooga, TN · On-site

Aldridge Pite, LLP is a multi-state law firm that focuses heavily on the utilization of technology ... Update internal Case Management System * Assist with other duties and special projects as needed ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Cleveland, TN

Utilization Review Manager information

See Cleveland, TN salary details

$32.6K

$76.1K

$140.1K

How much do utilization review manager jobs pay per year?

As of Aug 24, 2026, the average yearly pay for utilization review manager in Cleveland, TN is $76,147.00, according to ZipRecruiter salary data. Most workers in this role earn between $49,800.00 and $91,600.00 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 Cleveland, TN?

The most popular types of Utilization Review jobs in Cleveland, TN are:

What are popular job titles related to Utilization Review Manager jobs in Cleveland, TN?

For Utilization Review Manager jobs in Cleveland, TN, the most frequently searched job titles are:

What job categories do people searching Utilization Review Manager jobs in Cleveland, TN look for?

The top searched job categories for Utilization Review Manager jobs in Cleveland, TN are:

What cities near Cleveland, TN are hiring for Utilization Review Manager jobs?

Cities near Cleveland, TN with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Cleveland, TN as of August 2026, with employment types broken down into 82% Full Time, 17% Part Time, and 1% Contract. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution, with an average salary of $76,147 per year, or $36.6 per hour.

Utilization Management Nurse

HealthOne Alliance

Dalton, GA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 9 days ago

Job description

MISSION
Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES
HealthOne is guided by a cultural framework that embodies our values and drives our decisions.
Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.


JOB PURPOSE
The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms.

ESSENTIAL JOB DUTIES
Initiate referrals to ensure appropriate coordination of care.
Seek the advice of the Medical Director when appropriate, according to policy.
Assists non-clinical staff in performance of administrative reviews
Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility.
Regular and predictable attendance
Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
Works to encourage and promote Company culture throughout the organization
Other duties as may be assigned


QUALIFICATIONS
3 years Clinical experience preferred
1-2 years of Utilization Review preferred
Proficient in Microsoft Office (Outlook, Word, Excel)
Working knowledge of NCQA preferred
Must be able to work in an independent and creative manner.
Ability to manage multiple projects and priorities
Adaptive to high pace and changing environment
Customer service oriented
Proficient in interpreting benefits, contract language and medical policy/medical review criteria
Current, active Compact State license in Nursing (RN).


PHYSICAL REQUIREMENTS
Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.


BENEFITS
401K (4% Match, Immediate Vesting)

Accident insurance
Competitive salary

Critical Illness Insurance

Dental Insurance
Employee Assistance Program

Flexible Spending Account

Health & Wellness Program

Health Savings Account

Life & AD&D Insurance

Long Term Disability

Medical Insurance
Paid Time Off

Pet Insurance
Short Term Disability

Vision Insurance


PRE-EMPLOYMENT SCREENING
Drug Screen and Background Check Required

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.

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