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Utilization Review Manager Jobs in Portland, ME (NOW HIRING)

Encompass Health

Case Manager

Portland, ME · On-site

$20.50 - $26.25/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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Showing results 21-40

All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Portland, ME

Utilization Review Manager information

See Portland, ME salary details

$38.2K

$89K

$163.9K

How much do utilization review manager jobs pay per year?

As of Sep 2, 2026, the average yearly pay for utilization review manager in Portland, ME is $89,044.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,200.00 and $107,100.00 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 Portland, ME?

The most popular types of Utilization Review jobs in Portland, ME are:

What are popular job titles related to Utilization Review Manager jobs in Portland, ME?

For Utilization Review Manager jobs in Portland, ME, the most frequently searched job titles are:

What job categories do people searching Utilization Review Manager jobs in Portland, ME look for?

The top searched job categories for Utilization Review Manager jobs in Portland, ME are:

What cities near Portland, ME are hiring for Utilization Review Manager jobs?

Cities near Portland, ME with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Portland, ME as of August 2026, with employment types broken down into 80% Full Time, 19% Part Time, and 1% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $89,044 per year, or $42.8 per hour.

Director of Case Management

Central Maine Medical Center

Freeport, ME • On-site

$105K - $153K/yr

Full-time

Posted 29 days ago

Central Maine Medical Center rating

5.5

Company rating: 5.5 out of 10

Based on 42 frontline employees who took The Breakroom Quiz

944th of 1,064 rated hospitals

Job description

Overview:

Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center  (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service.

CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities.

As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing and medical imaging school. The private, not-for-profit institution is accredited by the New England Commission of Higher Education and plays an important role in training the next generation of healthcare professionals.

To learn more, visit www.cmhc.org.

Responsibilities:

The Director of Case Management is responsible for the development of staff and systems to effectively operate a comprehensive Case Management Program. Provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians.  Assesses needs and plans, communicates and designs services that are appropriate to the hospital mission and patient/family needs.  Integrates and coordinates services using continuous quality improvement tools.

#appcast

Qualifications:

Required qualifications:

  1.  Licensed clinician in your state.
  2. Grandfathered prior to April 1, 2015. Minimum 5 years’ post graduate of an accredited school of Social Work for Licensed Clinical Social Worker.
  3. Minimum 5 years’ experience in a Case Management position.
  4. Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.
  5. Experience and knowledge in basic to intermediate computer skills.

Preferred qualifications:

  1. Certification in Case Management, BS or BSN or related field preferred.
  2. Current BCLS certificate preferred.
  3.  Knowledge of Milliman Criteria and InterQual Criteria preferred.

#LI-SM6

#LI-TA1

Pay Transparency:

Central Maine Medical Center offers competitive compensation and a reasonable compensation estimate for this role is $105,955 to $153,441. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

Employment Status: Full Time Shift: Days Equal Employment Opportunity:

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

What Central Maine Medical Center employees say

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About Central Maine Medical Center

Sourced by ZipRecruiter

Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoast Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services. If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Lewiston, ME, US

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