ZipRecruiter

Log In

1

Utilization Review Manager Jobs in Rochester, MN

CVS Health

Grad Pharmacist

Rochester, MN

$17 - $21/hr

... quality assurance drug utilization review (DUR), pharmacy professional standards such as ... the management, oversight, and operations within the pharmacy, including but not limited to:

Benchmark

Technical Program Manager I

Rochester, MN · On-site

$79K - $99K/yr

... leading, business review meetings with Benchmark and customer • Seek additional sales ... product, utilization, strategies and requirements to support launch activity and business ...

Vizient

Contract Manager - Mayo Clinic

Rochester, MN

$77K - $135K/yr

... reviews, facilitating stakeholder communications, and coordinating contract launch and ... Proven analytical skills with the ability to interpret financial, utilization, and market data to ...

next page

Showing results 1-20

All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Rochester, MN

Utilization Review Manager information

See Rochester, MN salary details

$39.6K

$92.5K

$170.3K

How much do utilization review manager jobs pay per year?

As of Jul 21, 2026, the average yearly pay for utilization review manager in Rochester, MN is $92,512.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,500.00 and $111,300.00 per year, depending on experience, location, and employer.

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, and why are they important?

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 Rochester, MN? The most popular types of Utilization Review jobs in Rochester, MN are:
What are popular job titles related to Utilization Review Manager jobs in Rochester, MN? For Utilization Review Manager jobs in Rochester, MN, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Rochester, MN look for? The top searched job categories for Utilization Review Manager jobs in Rochester, MN are:
What cities near Rochester, MN are hiring for Utilization Review Manager jobs? Cities near Rochester, MN with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you

MDS Solutions - Clinical Reimbursement Specialist

MDS Solutions

Rochester, MN • On-site, Remote

Other

Medical, Dental, Life, Retirement, PTO

Posted 12 days ago

Job description

Overview
MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS division as a Clinical Reimbursement Specialist.
Clinical Reimbursement Specialist (CRS)
The Clinical Reimbursement Specialist (CRS) plays a critical role in supporting clients through specialized project work, including conducting RAI assessments, developing comprehensive care plans, and delivering targeted education and training to MDS Coordinators on the Resident Assessment Instrument (RAI) process. This work is performed in strict alignment with applicable laws, regulations, and company standards. The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized reimbursement. Additionally, the CRS provides support with interim long-term and short-term contract coordination, ensuring the smooth completion of these efforts
About Us:
At Key Rehab, we're shaking up rehab services with a fresh, standout approach. We offer a wide range of services, stick to top-notch systems, and work in strategic locations to get the best results for our patients and support our clients' goals. We're all about clear communication, using our deep experience to deliver therapy that's both effective and affordable. Our reputation is built on great patient care, happy clients and staff, and solid management. We are proud to exceed expectations for patients, families, healthcare providers, and businesses.
We prioritize both exceptional patient care and the well-being of our employees. We are committed to delivering compassionate, results-driven therapy while offering the flexibility and comprehensive benefits needed to thrive in today's healthcare environment. Our team is large enough to offer competitive pay and benefits but small enough to ensure personalized attention and support for your career aspirations.
Whether you're looking for a role that accommodates family commitments, travel plans, home projects, or future savings, we provide tailored solutions to fit your lifestyle. Join us and experience a workplace that values your individual needs and career goals. Come experience a rewarding career where you're valued and supported every step of the way.
We offer a creative, engaging, and flexible work environment, alongside a comprehensive benefits package designed to support your success and well-being:
  • Competitive salaries with bonus opportunities
  • Ample opportunities for promotion, transfer, and advancement
  • Work that is meaningful, fulfilling, and provides high job satisfaction
  • Reasonable working hours promoting work-life balance
  • Continuing education (CE) opportunities for ongoing professional development
  • Generous paid time off
  • Comprehensive health, dental, and life insurance packages
  • 401K with discretionary matching
  • Mileage and licensure reimbursements
  • Flexible Spending Account (FSA) and Health Savings Account (HSA) options

Responsibilities
  • Serve as a trusted advisor to healthcare agencies and facilities, offering expert guidance and insights to optimize their operations.
  • Assist clients in assessing, planning, developing, and implementing systems and processes related to reimbursement, tailored to the specific needs and contracts established with each client.
  • Provide consulting services and technical expertise, including interim MDS management, ensuring providers receive the support they need to achieve optimal outcomes.
  • Stay up-to-date on professional standards of clinical care, federal and state regulations, QM measures, and the RAI process to ensure the delivery of accurate, compliant, and effective solutions.
  • Deliver high-quality, professional services that encompass reimbursement optimization, staff education, in-depth research, system analysis, creative problem-solving, and the presentation of actionable recommendations to clients.
  • Identify and address training needs, developing and conducting training sessions or in-service programs as requested by clients to enhance staff competency and performance.
  • Operate within the defined scope of work, maintaining strict adherence to client agreements and expectations.
  • Uphold client confidentiality and ensure full compliance with HIPAA regulations, safeguarding sensitive information throughout the engagement.

Qualifications
Minimum Qualifications:
  • Bachelor's degree in nursing from an accredited college or university, with at least five (5) years of clinical experience, including 3+ years specializing in the RAI process.
  • Current and unrestricted RN ,along with active RAC-CT certification, ensuring adherence to industry standards and best practices.
  • Possesses exceptional critical thinking skills, with the proven ability to make informed decisions, demonstrate sound clinical judgment, and apply expert knowledge in quality improvement concepts and processes.
  • Demonstrates strong leadership abilities and excels in interpersonal communication, fostering collaboration, and guiding teams to achieve optimal clinical outcomes.

Key Rehab is an equal opportunity employer/service provider.

Apply