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Utilization Review Manager Jobs in Lexington, IN

ScionHealth

Case Manager II

Louisville, KY · On-site

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

ScionHealth

Case Manager II PRN

Louisville, KY · On-site

Utilization Management Conducts medical necessity review for appropriate utilization of services from admission through discharge. * Promotes effective and efficient utilization of clinical resources.

Covelo Direct LLC

Medical Director

Louisville, KY · On-site

Experience with quality management, utilization review, peer review, credentialing, and performance improvement * PACE, geriatrics, Medicare Advantage, managed care, SNF, or value-based care ...

Encompass Health

Case Manager

Louisville, KY · On-site

$19.25 - $24.75/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 ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Lexington, IN

Utilization Review Manager information

See Lexington, IN salary details

$37.2K

$86.9K

$159.9K

How much do utilization review manager jobs pay per year?

As of Sep 2, 2026, the average yearly pay for utilization review manager in Lexington, IN is $86,901.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,800.00 and $104,600.00 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 cities near Lexington, IN are hiring for Utilization Review Manager jobs?

Cities near Lexington, IN with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Lexington, IN as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $86,901 per year, or $41.8 per hour.

UTILIZATION REVIEW RN

Schneck Medical Center

Seymour, IN • On-site

Full-time

Re-posted 9 days ago

Schneck Medical Center rating

7.2

Company rating: 7.2 out of 10

Based on 14 frontline employees who took The Breakroom Quiz

425th of 1,064 rated hospitals

Job description

SALARY / 8:00am - 5:00pm / with on-call, weekend, & holiday rotation required
ELIGIBLE FOR $2,000 SIGN-ON BONUS!
JOB REQUIREMENTS
EDUCATION
Minimum: Graduate of accredited school of nursing (BSN Preferred)
Preferred: Bachelors Degree in Nursing with case management certification
LICENSE/CERTIFICATION
Licensed RN in State of Indiana. Certification plan in place within 24 months of hire.
EXPERIENCEMinimum: 2-3 years of acute care clinical experiencePreferred: 3-5 years of acute care clinical experience with strong knowledge of medical necessity criter and payer requirements
JOB DUTIES1. Utilization Review and Medical Necessity
2. Concurrent Review and Length of Stay Management
3. Retrospective Review
4. Payer Communication & Authorization
5. Denials Management and Appeals
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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