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Utilization Review Manager Jobs in Riverside, NJ

ScionHealth

Per Diem Case Manager II

Philadelphia, PA · On-site

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

Dane Street

Board-Certified Rheumatologist

Hainesport, NJ · On-site

$277K - $358K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Riverside, NJ

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 20, 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.

Clinical Review RN PRN

Cooper University Hospital

Camden, NJ • On-site

$61/hr

Per diem

Medical, Dental, Vision, Life, Retirement

Re-posted 27 days ago

Cooper University Health Care rating

7.5

Company rating: 7.5 out of 10

Based on 133 frontline employees who took The Breakroom Quiz

236th of 889 rated healthcare providers

Job description

About Us
AtCooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.
Discover why Cooper University Health Care is the employer of choice in South Jersey.
Short Description
  • Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity. Performs utilization review in accordance with all state mandated regulations.
  • Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
  • Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
  • Completes documentation of review and denial processes in the EPIC Case Management Module. Responds to requests from the payer for all required information and treatment plans.
  • Reviews and validates physician's orders, reports progress and unusual occurrences on patients to the payer.

Experience Required
3-5 years of recent clinical experience, preferably in area of population specialty.
Experience in utilization management or review preferred.
Knowledge and understanding of disease protocols and clinical pathways for commercial and government payors. Familiarity with Interqual and Millimen guidelines and regulatory mandates preferred.
Strong communication (written and verbal) and critical thinking skills required. Professional and effective presentation skills required.
Education Requirements
Bachelor's degree in Nursing preferred
License/Certification Requirements
Current NJ-RN License required.
Special Requirements
Monday availability is required.
Salary Min ($)
USD $37.00
Salary Max ($)
USD $61.00

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