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Utilization Review Manager Jobs in Hamilton, OH (NOW HIRING)

TriHealth

Care Management Coord RN

Oxford, OH · On-site

We are looking for a Care Mgmt Coord RN at McCullough-Hyde/TriHealth Facility in Oxford, OH Make a ... Performs utilization review for patients served. Requires weekend, holiday, and off site commitment ...

TriHealth

Care Management Coord RN

Oxford, OH · On-site

We are looking for a Care Mgmt Coord RN at McCullough-Hyde/TriHealth Facility in Oxford, OH Make a ... Performs utilization review for patients served. Requires weekend, holiday, and off site commitment ...

ChenMed

Administrative/CEO Physician

Cincinnati, OH · On-site

Focus on utilization review, manage care transitions, and participate in targeted coverage time. * Market Engagement: Contribute to team meetings, clinical discussions, and quality management ...

TriHealth, Inc.

Care Management Coord RN

Oxford, OH · On-site

We are looking for a Care Mgmt Coord RN at McCullough-Hyde/TriHealth Facility in Oxford, OH Make a ... Performs utilization review for patients served. Requires weekend, holiday, and off site commitment ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Hamilton, OH

Utilization Review Manager information

See Hamilton, OH salary details

$36.3K

$84.8K

$156K

How much do utilization review manager jobs pay per year?

As of Sep 8, 2026, the average yearly pay for utilization review manager in Hamilton, OH is $84,773.00, according to ZipRecruiter salary data. Most workers in this role earn between $55,400.00 and $102,000.00 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 Hamilton, OH?

The most popular types of Utilization Review jobs in Hamilton, OH are:

What are popular job titles related to Utilization Review Manager jobs in Hamilton, OH?

For Utilization Review Manager jobs in Hamilton, OH, the most frequently searched job titles are:

What job categories do people searching Utilization Review Manager jobs in Hamilton, OH look for?

The top searched job categories for Utilization Review Manager jobs in Hamilton, OH are:

What cities near Hamilton, OH are hiring for Utilization Review Manager jobs?

Cities near Hamilton, OH with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Hamilton, OH as of August 2026, with employment types broken down into 86% Full Time, 13% Part Time, and 1% Contract. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $84,773 per year, or $40.8 per hour.

Director of Utilization Review

New Vista Behavioral Health

Cincinnati, OH

$78K - $100K/yr

Full-time

Posted 4 days ago

Job description

Corporate Director of Utilization Review

New Vista Behavioral Health

Pay Range: $78k - $100k per year
Schedule: Full Time
Location: Blue Ash, OH

New Vista Behavioral Health is seeking an experienced Corporate Director of Utilization Review to provide strategic leadership and oversight of utilization review and utilization management across our behavioral health organization.

This is a high-impact corporate leadership role responsible for ensuring clinically appropriate, timely, and financially responsible utilization of behavioral health services. The Director will partner with clinical, medical, operations, revenue cycle, quality, compliance, admissions, discharge planning, and payer relations teams to optimize authorizations, reduce avoidable denials, support appropriate length of stay, and promote timely transitions of care.

Key Responsibilities
  • Lead and oversee the organization’s enterprise-wide Utilization Review program and establish consistent best practices across facilities and programs.
  • Develop and implement standardized UR policies, workflows, performance expectations, and quality metrics.
  • Oversee initial, concurrent, continued-stay, retrospective, and discharge-related utilization reviews.
  • Ensure timely and accurate submission of clinical information and authorization requests to managed care organizations and other payers.
  • Monitor authorization outcomes, denials, length of stay, continued-stay days, and other utilization trends.
  • Develop strategies to prevent avoidable denials and improve payer authorization and appeal outcomes.
  • Oversee peer-to-peer reviews, clinical escalations, and medical necessity appeals.
  • Partner with clinical leadership to ensure documentation supports medical necessity, level of care, treatment needs, and continued stay.
  • Establish and monitor corporate UR dashboards and key performance indicators.
  • Identify trends and opportunities for operational, clinical, and financial improvement.
  • Provide coaching, mentoring, and leadership to facility-level UR teams and managers.
  • Collaborate with Revenue Cycle, Payer Relations, Quality, Compliance, Medical Staff, and Operations to resolve utilization and reimbursement challenges.
  • Maintain compliance with applicable regulatory, accreditation, payer, and organizational requirements.
  • Serve as the organization’s subject-matter expert on behavioral health utilization management and medical necessity.
Qualifications
  • Bachelor’s degree in Nursing, Healthcare Administration, Social Work, Psychology, or a related healthcare field required.
  • Master’s degree preferred.
  • Active clinical license or applicable professional credential preferred.
  • 7+ years of progressive healthcare experience, including significant behavioral health utilization review/management experience.
  • 3–5+ years of leadership experience, preferably in a multi-site or corporate healthcare environment.
  • Strong knowledge of behavioral health levels of care, medical necessity, payer authorization, concurrent review, denials, peer-to-peer reviews, and appeals.
  • Demonstrated success improving authorization outcomes and reducing avoidable denials.
  • Strong analytical, organizational, communication, and leadership skills.
  • Experience with behavioral health EHRs, payer portals, and utilization management systems preferred.
  • Knowledge of InterQual, MCG, ASAM, LOCUS, or other applicable clinical criteria is a plus.

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