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

MDB Health Services

Care Management Director

Flowood, MS · On-site

$80 - $100/hr

The ideal candidate is a strong clinical leader with experience in care management, utilization review, and interdisciplinary team leadership. Key Responsibilities * Provide leadership and oversight ...

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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 Sep 4, 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.

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 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.

Care Management Director

MDB Health Services

Flowood, MS • On-site

$80 - $100/hr

Other

Re-posted 10 days ago

Job description

MDB Health Services provides medical and psychiatric services to residents in long‑term care facilities across Mississippi, Louisiana, Arkansas, Tennessee, Kentucky, and Texas. As the region’s largest LTC healthcare provider, we are proud to have an exceptional team of physicians, nurse practitioners, and therapists dedicated to delivering high‑quality, compassionate care. For more than 13 years, we have built a strong reputation among both clinicians and long‑term care communities by going above and beyond to help facilities provide the best possible healthcare to their residents while remaining people‑first in everything we do.

Position Summary

We are seeking an experienced and compassionate Director of Care Management to lead and oversee the daily operations, strategic development, and quality performance of our chronic care management and behavioral health integration services. This leadership role is responsible for ensuring high‑quality, patient‑centered care coordination while driving operational efficiency, compliance, and positive clinical outcomes.

The ideal candidate is a strong clinical leader with experience in care management, utilization review, and interdisciplinary team leadership.

Key Responsibilities
  • Provide leadership and oversight for all care management program operations
  • Develop and implement strategies to improve patient outcomes, reduce readmissions, and enhance care transitions
  • Supervise and train care management staff
  • Monitor quality metrics, KPIs, and regulatory compliance standards
  • Collaborate with providers, administration, and interdisciplinary teams to improve coordination of care
  • Oversee utilization management, care planning, and resource coordination processes
  • Conduct program evaluations and identify opportunities for workflow and performance improvement
  • Ensure accurate documentation and compliance with organizational, state, and federal requirements
  • Assist with policy development, staff education, and process standardization
Qualifications
  • Registered Nurse (RN) required; BSN preferred
  • Minimum 5 years of care management in hospital, outpatient, behavioral health, or multi‑site healthcare settings
  • Minimum 2 years of leadership or supervisory experience
  • Strong knowledge of healthcare regulations, utilization review, discharge planning, and quality improvement
  • Experience with EMR systems and healthcare documentation standards
  • Excellent communication, leadership, organizational, and problem‑solving skills
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