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Utilization Review Manager Jobs in Madison, MS (NOW HIRING)

FMOLHS

Experienced Case Manager - RN

Jackson, MS

The Case Manager directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific ...

GQR Global Markets

RN Case Manager

Jackson, MS · On-site

$2.2K - $2.3K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Jackson, Mississippi Start Date: August 6, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $2241 ...

New

GQR

RN - Case Manager

Jackson, MS · On-site

$2.2K - $2.3K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Jackson, Mississippi Start Date: August 6, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $2241 ...

Humana

Compliance UM Nurse (Wed - Sun)

Jackson, MS · On-site

Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...

Telligen

Peer Review Psychiatrist

Jackson, MS · On-site

As a Peer Review Psychiatrist, you will conduct peer reviews and appeals to ensure the level of ... Proven background in utilization management and several years of hands-on clinical practice

New

UnitiMed

RN Case Manager

Jackson, MS · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Madison, MS

Utilization Review Manager information

See Madison, MS salary details

$31.7K

$74K

$136.3K

How much do utilization review manager jobs pay per year?

As of Aug 14, 2026, the average yearly pay for utilization review manager in Madison, MS is $74,047.00, according to ZipRecruiter salary data. Most workers in this role earn between $48,400.00 and $89,100.00 per year, depending on experience, location, and employer.

Is utilization review a stressful job?

Utilization review managers oversee the assessment of healthcare services to ensure appropriate and efficient care, which can involve high workloads and strict deadlines, leading to stress. The job requires strong organizational skills, attention to detail, and the ability to handle complex cases, which may contribute to job-related stress for some individuals.

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 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 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.

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 most commonly searched types of Utilization Review jobs in Madison, MS?

The most popular types of Utilization Review jobs in Madison, MS are:

What are popular job titles related to Utilization Review Manager jobs in Madison, MS?

For Utilization Review Manager jobs in Madison, MS, the most frequently searched job titles are:

What job categories do people searching Utilization Review Manager jobs in Madison, MS look for?

The top searched job categories for Utilization Review Manager jobs in Madison, MS are:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Madison, MS as of August 2026, with employment types broken down into 95% Full Time, and 5% Part Time. Highlights an 82% In-person, and 18% Remote job distribution, with an average salary of $74,047 per year, or $35.6 per hour.

RN - Utilization Review - Utilization Review

University of Mississippi Medical Center

Jackson, MS • On-site

Other

This job post has expired 5 days ago. Applications are no longer accepted.

University Of Mississippi Medical Center rating

7.4

Company rating: 7.4 out of 10

Based on 47 frontline employees who took The Breakroom Quiz

348th of 1,059 rated hospitals

Job description

Hello,
Thank you for your interest in career opportunities with the University of Mississippi Medical Center. Please review the following instructions prior to submitting your job application:

  • Provide all of your employment history, education, and licenses/certifications/registrations. You will be unable to modify your application after you have submitted it.
  • You must meet all of the job requirements at the time of submitting the application.
  • You can only apply one time to a job requisition.
  • Once you start the application process you cannot save your work. Please ensure you have all required attachment(s) available to complete your application before you begin the process.
  • Applications must be submitted prior to the close of the recruitment. Once recruitment has closed, applications will no longer be accepted.
After you apply, we will review your qualifications and contact you if your application is among the most highly qualified. Due to the large volume of applications, we are unable to individually respond to all applicants. You may check the status of your application via your Candidate Profile.
Thank you,
Human Resources
Important Applications Instructions:
Please complete this application in entirety by providing all of your work experience, education and certifications/
license. You will be unable to edit/add/change your application once it is submitted.
Job Requisition ID:
R00050784
Job Category:
Nursing
Organization:
Utilization Review
Location/s:
Main Campus Jackson
Job Title:
RN - Utilization Review - Utilization Review
Job Summary:
RN-Utilization Review is accountable to perform utilization management services for designated patient case load, including prospective, concurrent, retrospective, and denial management reviews by applying clinical protocols and review medical necessity criteria. Reports quality of care issues identified during the utilization management process to the appropriate manager.
Education & Experience
Education and Experience Required:
One (1) year of nursing experience in an inpatient setting.
Certifications, Licenses, or Registration required:
Valid RN license.
Knowledge, Skills & Abilities
Knowledge, Skills, and Abilities:
Knowledge of utilization review, discharge planning, case management, and managed care reimbursement. Strong working knowledge of medical procedures, diagnoses, and procedure codes, including ICD-10, CPT, and DSM-IV. Excellent interpersonal, verbal, written communication, and negotiation skills. Ability to gather data, prepare reports, and identify process improvements. Able to work independently, exercise sound judgment, and apply medical necessity guidelines with minimal supervision. Committed to quality patient care, customer service, safety, cost efficiency, and continuous quality improvement (CQI). Proficient in the use of computers and related software applications.
Responsibilities:
  • Performs prospective, concurrent, retrospective, and denials review for individual cases, including benefit coverage, medical necessity, appropriate level of care, and mandated services.
  • Assists in collecting and reporting financial and performance indicators, including case mix, length of stay, cost per case, resource utilization, readmission rates, denials, and appeals.
  • Uses data to drive decisions and implement performance improvement strategies related to case management, including fiscal, clinical, and patient satisfaction outcomes.
  • Collects and analyzes variances from the plan of care and collaborates with physicians and the healthcare team to address issues and improve outcomes.
  • Applies clinical appropriateness criteria to monitor admissions and continued stays, identifies at-risk populations, and refers cases to the care management physician advisor as needed.
  • Communicates with third-party payers to facilitate reimbursement certification, resolves payor issues, and completes utilization management and quality screening for assigned patients.
  • Works collaboratively with the interdisciplinary care team to ensure timely, appropriate patient management, remove barriers to care, and proactively address delays or discharge obstacles.
  • Ensures safe, high-quality care in compliance with policies, procedures, and standards, while managing time, supplies, productivity, and accuracy within budgetary guidelines.
  • The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands:
Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, no handling or working with potentially dangerous equipment, occasional working hours beyond regularly scheduled hours, occasional travelling to offsite locations, occasional activities subject to significant volume changes of a seasonal/clinical nature, occasional work produced is subject to precise measures of quantity and quality, occasional bending, occasional lifting/carrying up to 10 pounds, occasional lifting/carrying up to 25 pounds, no lifting/carrying up to 50 pounds, no lifting/carrying up to 75 pounds, no lifting/carrying up to100 pounds, no lifting/carrying 100 pounds or more, no climbing, no crawling, occasional crouching/stooping, no driving, occasional kneeling, occasional pushing/pulling, occasional reaching, frequent sitting, occasional standing ,occasional twisting, and frequent walking. (Occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)
Time Type:
Full time
FLSA Designation/Job Exempt:
Yes
Pay Class:
Salary
FTE %:
100
Work Shift:
Day
Benefits Eligibility:
Grant Funded:
No
Job Posting Date:
07/7/2026
Job Closing Date (open until filled if no date specified):

What University Of Mississippi Medical Center employees say

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About University of Mississippi Medical Center

Sourced by ZipRecruiter

The University of Mississippi Medical Center (UMMC) is the state's sole academic medical center, focused on enhancing the lives of Mississippi residents through education, research, and healthcare. UMMC houses seven health science schools with over 3,000 enrolled students, and its researchers are renowned for their contributions to areas like heart disease, diabetes, hypertension, and cancer treatment. Their efforts not only improve health outcomes but also drive economic growth and job opportunities in the state.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Jackson, MS, US

Year founded

1955

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