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Utilization Review Manager Jobs (NOW HIRING)

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL

The Director of Utilization Management is also responsible for ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS. The Director: interfaces with clinical ...

Stcharles

Utilization Review Specialist

Bend, OR · On-site

$27.74 - $41.61/hr

Manager - Utilization Management DEPARTMENT: Utilization Management DATE LAST REVIEWED: August 2025 OUR VISION: Creating America's healthiest community, together OUR MISSION: In the spirit of love ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Harahan, LA

River Oaks Hospital is seeking a dynamic and talented UTILIZATION REVIEW DIRECTOR to direct and serve within the Utilization Management team. Evaluates patient medical records to determine severity ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Collaborate with physicians, case management, and care teams * Support discharge planning and care ...

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Utilization Review Manager information

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$39K

$91K

$167.5K

How much do utilization review manager jobs pay per year?

As of Jul 6, 2026, the average yearly pay for utilization review manager in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 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.
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Utilization Review Manager jobs near you
Utilization Review Manager (On-site) (279)

Utilization Review Manager (On-site) (279)

LifeStream Behavioral Center

Leesburg, FL • On-site

$34.05/hr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 13 days ago

Job description

Job Purpose:
- The Utilization Review Manager - RN at LIFESTREAM BEHAVIORAL CENTER is responsible for overseeing the utilization review process to ensure that patient care services are delivered efficiently and effectively. This role involves collaborating with healthcare providers to optimize patient outcomes and resource utilization while ensuring compliance with regulatory and accreditation standards.
Key Responsibilities:
- Lead and manage the utilization review team to ensure timely and accurate assessments of patient care plans.
- Develop and implement utilization review policies and procedures in accordance with organizational and regulatory requirements.
- Collaborate with clinical staff to review patient cases and determine the appropriateness of care and services provided.
- Analyze data and prepare reports on utilization trends, recommending improvements to enhance patient care and resource management.
- Serve as a liaison between the healthcare team and insurance providers to facilitate authorizations and resolve any coverage issues.
- Provide education and training to staff on utilization review processes and best practices.
- Ensure compliance with all relevant regulations, standards, and guidelines related to utilization management.
- Participate in quality improvement initiatives to enhance the efficiency and effectiveness of patient care delivery.
Required Education:
- Current Registered Nurse (RN) license in the state of Florida or Florida Licensure as a clinical social worker, mental health counselor, or marriage and family therapist. Master's degree preferred.
Required Experience:
- Minimum of 3 years of clinical nursing experience, social work, or psychology preferably in a behavioral health or psychiatric setting.
- Minimum of 3 years of experience in utilization review or case management within a hospital and/or behavioral health.
- 3+ years of supervisory or management experience required.
Required Skills and Abilities:
- Strong understanding of utilization review processes and healthcare regulations.
- Excellent analytical skills to assess patient care needs and determine appropriate levels of service.
- Proficient in electronic medical records (EMR) systems and healthcare management software.
- Exceptional communication and interpersonal skills to collaborate with healthcare providers, patients, and insurance companies.
- Ability to lead and motivate a team, ensuring compliance with organizational policies and procedures.
- Detail-oriented with strong organizational skills to manage multiple cases simultaneously.
- Ability to handle sensitive information with confidentiality and professionalism.
LifeStream Benefits
  • Health/Dental/Vision Insurance
  • Short Term Disability
  • Pension Plan
  • 403(b)
  • PTO (Over 4 weeks your 1st year!)
  • Flexible Work Schedules
  • Tuition Reimbursement Program
  • Free Telehealth Services
  • HRSA
  • And More!

Important Notice
As part of our hiring process and in compliance with Section 435.04, Florida Statutes, certain positions require a Level 2 background screening. Employment offers are contingent upon meeting applicable requirements. For more details on Level 2 background screening requirements, please visit: Florida Care Provider Background Screening Clearinghouse
LifeStream is an equal opportunity employer and does not discriminate against any applicant based on age, citizenship, color, covered veteran status, disability, gender identity, genetic information, marital status, race, religion, sex, sexual orientation, or other protected status in accordance with applicable federal, state, and local laws.

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