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Utilization Review Manager Jobs in Rochester, MN

Oak St. Health

Grad Pharmacist

Rochester, MN · On-site

$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:

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:

CVS Health

Grad Pharmacist

Rochester, MN · On-site

$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 ...

Mayo Clinic

Sr Manager, Connect

Rochester, MN · On-site

$113K - $113K/yr

Facilitate executive governance meetings, strategic planning sessions, and business reviews in ... Monitor portfolio health, delivery quality, customer satisfaction, utilization, and operational ...

Mayo Clinic

Sr Manager, Connect

Rochester, MN · On-site

$113K - $113K/yr

Facilitate executive governance meetings, strategic planning sessions, and business reviews in ... Monitor portfolio health, delivery quality, customer satisfaction, utilization, and operational ...

Mayo Clinic

Sr Manager, Connect

Rochester, MN · On-site

$117K - $118K/yr

Facilitate executive governance meetings, strategic planning sessions, and business reviews in ... Monitor portfolio health, delivery quality, customer satisfaction, utilization, and operational ...

Guida's Dairy

Plant Engineering Manager

Zumbrota, MN · On-site

Responsible for asset management including maximizing utilization, replacement, upgrading ... Coordinate with on-site staff and DFA management or engineering to review and approve plans for new ...

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

Utilization Review Manager information

See Rochester, MN salary details

$38.1K

$88.9K

$163.5K

How much do utilization review manager jobs pay per year?

As of Aug 12, 2026, the average yearly pay for utilization review manager in Rochester, MN is $88,852.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,100.00 and $106,900.00 per year, depending on experience, location, and employer.

Is utilization review a stressful job?

Utilization review managers oversee the assessment of healthcare services to ensure appropriate and efficient care, which can involve high workloads and strict deadlines, leading to stress. The job requires strong organizational skills, attention to detail, and the ability to handle complex cases, which may contribute to job-related stress for some individuals.

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?

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:
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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

Clinical Appeals Specialist II-Hybrid

Mayo Clinic

Rochester, MN • Hybrid

Full-time

Medical, Dental, Vision, Retirement

Posted 12 days ago

Mayo Clinic rating

7.8

Company rating: 7.8 out of 10

Based on 697 frontline employees who took The Breakroom Quiz

130th of 887 rated healthcare providers

Job description

This is a hybrid position and must be located within 100 miles of any of the Mayo Clinic campuses for on-site expectations based on business needs. 

Primary duties may include, but are not limited to, responsibility for reviewing assigned clinically related denials, payer audits, and payer correspondence as well as preparation of relevant appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the evaluation of medical records against appropriate criteria and contract requirements and utilizes appropriate communication style to appeal or defend medically denied claims. Is a liaison and resource to revenue cycle, case management and practice stakeholders in defending clinically denied claims and providing relevant feedback to key stakeholders on denial prevention opportunities.

Why Mayo Clinic

Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans - to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic.

Benefits Highlights
  • Medical: Multiple plan options.
  • Dental: Delta Dental or reimbursement account for flexible coverage.
  • Vision: Affordable plan with national network.
  • Pre-Tax Savings: HSA and FSAs for eligible expenses.
  • Retirement: Competitive retirement package to secure your future.
Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is. 

Equal Opportunity

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status or disability status. Learn more about the "EOE is the Law".  Mayo Clinic participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.

Minimum Education: Associates Degree

Minimum Experience:  3 years of relevant nursing experience

Current active unrestricted RN license.

The preferred applicant will have the following experience: Advanced knowledge of ICD-10-CM/PCS coding conventions, DRG reimbursement methodology, and clinical validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare IPPS regulations to support accurate DRG assignment and defend coding-related denials.

Healthcare Financial Management Association (HFMA) Certification Preferred.

CCDS or CDIP Certification Preferred. 

Experience in utilization review, case management, denials and appeals, revenue cycle, or prior authorization preferred. Knowledge and use of discharge planning, case management, utilization review, and levels of care criteria. Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements. Knowledge and use of payer medical policy and Medicare LCD/NCD criteria. Knowledge of billing and coding requirements. Experience utilizing Milliman Care Guidelines and InterQual Criteria. Knowledge of current NCQA/URAC standards. Knowledge and experience applying 2-Midnight Rule Criteria. Knowledge and experience in Epic. Must have the ability to effectively utilize Microsoft Office Suite and possess basic data entry skills. Must possess excellent verbal, written and interpersonal communication skills, and able to balance multiple demands and respond to time constraints. Must have high-level skills in organization as well as problem solving and analytical skills. 


**This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.

What Mayo Clinic employees say

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About Mayo Clinic

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Mayo Clinic is the largest integrated, not-for-profit medical group practice in the world. We're building the future, one where the best possible care is available to everyone — and more people can heal at home. Our relentless research turns into earlier diagnoses and new cures. That's how we inspire hope in those who need it most. At Mayo Clinic, experts work together to solve the most challenging unmet needs of patients. Our history of innovation dates back almost 150 years, when brothers Will and Charlie Mayo pioneered an integrated, team-based approach to medicine. Today, that trailblazing spirit drives innovations like Mayo Clinic Platform — which powers new technologies to change how care is delivered to all.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Rochester, MN, US

Year founded

1919

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