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Utilization Review Manager Jobs in Converse, TX (NOW HIRING)

Dane Street, LLC

Chiropractor

San Antonio, TX

$69K - $84K/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

Chiropractor

San Antonio, TX · On-site

$69K - $84K/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

Chiropractor

San Antonio, TX · On-site

$69K - $85K/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

Chiropractor

San Antonio, TX · On-site

$69K - $84K/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

ScionHealth

PRN Case Manager II Days

San Antonio, TX · On-site

$19.50 - $25.75/hr

... utilization review and management, and discharge planning. Essential Functions Care Coordination ... Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Converse, TX

Utilization Review Manager information

See Converse, TX salary details

$35.4K

$82.6K

$152.1K

How much do utilization review manager jobs pay per year?

As of Aug 21, 2026, the average yearly pay for utilization review manager in Converse, TX is $82,646.00, 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 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 cities near Converse, TX are hiring for Utilization Review Manager jobs?

Cities near Converse, TX with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Converse, TX as of August 2026, with employment types broken down into 84% Full Time, 15% Part Time, and 1% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $82,646 per year, or $39.7 per hour.

Hospital - Utilization Review Care Coordinator (RN)

UT Health San Antonio

San Antonio, TX • On-site

Other

Posted 9 days ago

UT Health San Antonio rating

7.2

Company rating: 7.2 out of 10

Based on 44 frontline employees who took The Breakroom Quiz

385th of 620 rated colleges and universities

Job description

Utilization Review Care Coordinator

The Utilization Review (UR) Care Coordinator in the Care Management Department will be responsible for ensuring the appropriate use of healthcare resources while maintaining high standards of patient care. The individual in this position will review patient cases, monitor treatment plans, and collaborate with healthcare providers to optimize care delivery and resource utilization.

Responsibilities
  • Conduct utilization reviews to ensure medical necessity, appropriateness, and efficiency of healthcare services.
  • Evaluate patient records, treatment plans, and clinical documentation to verify that services meet established guidelines and standards.
  • Collaborate with physicians, nurses, case managers, and other healthcare providers to discuss patient care and identify opportunities for improvement.
  • Facilitate the authorization process for hospital admissions, treatments, and procedures with insurance companies and payers.
  • Monitor patient progress and discharge plans to ensure timely and appropriate transitions of care.
  • Educate patients, families, and healthcare providers about utilization review processes and requirements.
  • Maintain accurate and detailed documentation of reviews, findings, and actions taken.
  • Participate in interdisciplinary team meetings to discuss patient care and utilization management.
  • Stay current with industry regulations, standards, and best practices in utilization review and care management.
Qualifications
  • Comprehensive understanding of utilization review processes, guidelines, and regulations.
  • Knowledge of medical terminology, disease processes, and treatment protocols.
  • Familiarity with healthcare delivery systems and insurance requirements.
  • Understanding of regulatory requirements, including Medicare and Medicaid guidelines.
  • Strong analytical and critical thinking skills.
  • Proficient in reviewing and interpreting medical records and clinical documentation.
  • Ability to work collaboratively with a multidisciplinary healthcare team.
  • Capacity to handle multiple priorities and manage complex cases.
  • Ability to advocate for patients and ensure the appropriate use of healthcare resources.
  • Flexibility and adaptability to meet the diverse needs of patients and the healthcare system.

Education

  • Bachelor's in Nursing

Certification/Licensure:

  • Registered Nurse (RN)
Required Skills
  • Minimum of 3 years of clinical nursing experience. Minimum of 2 years in utilization review. Experience with InterQual preferred. RN - Registered Nurse - State Licensure And/Or Compact State Licensure required.

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