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Utilization Review Manager Jobs in Riverside, NJ

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Utilization Review Manager information

See Riverside, NJ salary details

$39.4K

$91.9K

$169.2K

How much do utilization review manager jobs pay per year?

As of Aug 18, 2026, the average yearly pay for utilization review manager in Riverside, NJ is $91,921.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,100.00 and $110,600.00 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 are popular job titles related to Utilization Review Manager jobs in Riverside, NJ?

For Utilization Review Manager jobs in Riverside, NJ, the most frequently searched job titles are:

What cities near Riverside, NJ are hiring for Utilization Review Manager jobs?

Cities near Riverside, NJ with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Riverside, NJ as of August 2026, with employment types broken down into 90% Full Time, 9% Part Time, and 1% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $91,921 per year, or $44.2 per hour.

Utilization Review Analyst

EAGLEVILLE HOSPITAL

Eagleville, PA • On-site

Other

Re-posted 21 days ago

Job description

Eagleville Hospital, an independent substance use and behavioral health treatment and educational organization serving the community for more than a century, provides innovative compassionate care to those seeking treatment for stigmatized illnesses including substance use and mental health.
Position Summary
Review and abstract pertinent data from medical records and communicates information to all various insurance companies and/or their contractual agencies to guarantee continued financial coverage.
This position reports to the Utilization Review Director
Objectives / Responsibilities
  • Reviews admissions to determine medical necessity and appropriateness of treatment.
  • Reviews patient records to obtain justification of treatment.
  • Secures necessary data from the clinical team for extended stay reviews.
  • Presents abstracts (via telecon) of clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment.
  • Review, abstracts and assigns initial length of stay and extensions of treatment as appropriate for all payers as assigned
  • Communicates all extensions of treatment to clinical teams and Director, Utilization Review (UR)
  • Notify clinical teams of need for current documentation.
  • Refer cases to Director, UR when appropriateness of and necessity of extended stay is questionable.
  • Attend appropriate daily treatment team meeting
  • Salary Range: $50-$57/yr

Educational Requirements
  • Bachelor's Degree Preferred

Competencies
  • Patient-Centered Approach - Treat all individuals with dignity, empathy, and respect, recognizing that every role contributes to the patient experience.
  • Excellence & Accountability - Perform all duties with professionalism, following hospital policies to ensure safety, compliance, and efficiency.
  • Teamwork & Communication - Collaborate with colleagues across departments, maintaining a positive and solution-oriented attitude.
  • Commitment to Our Mission - Uphold the hospital's values and contribute to a culture of trust, inclusivity, and continuous improvement.

Qualifications
  • 3+ years of UR or case management experience in Substance Use /Behavioral Health
  • Good communication
  • Ability to work independently
  • Experience with Microsoft applications
  • Knowledge of pre-certification process and ASAM. Knowledge of DSM V, private care managers and county referral sources

Physical Requirements
  • Ability to sit for long periods
  • Ability to walk around campus if needed
  • Good dexterity, must be able to type
  • Use of telephone

Work Environment
  • Office setting

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