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Utilization Review Manager Jobs (NOW HIRING)

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...

Cobalt Benefits Group LLC

Director, Utilization Review

Exeter, NH · On-site

$135K - $155K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Director of Utilization Review is responsible for the strategic leadership, operational ... The position also advances technology-enabled utilization management, interoperability, and ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Springfield, IL

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Supervise, coach, and develop case managers and other assigned team members. * Ensure timely and accurate utilization review activities and payer communications. * Monitor patient progression ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...

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Utilization Review Manager information

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$91K

$167.5K

How much do utilization review manager jobs pay per year?

As of Aug 16, 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.

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.
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Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 12% Part Time, and 1% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $91,011 per year, or $43.8 per hour.

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL

Full-time

Re-posted 8 days ago

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

· Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  • Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

· Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

· Bachelor of Science in Nursing (BSN) preferred.

· Case Management Certification (e.g., CCM) is a plus.

· Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

· Minimum 2 years of work experience in Utilization Review

· Strong understanding of revenue cycle management and healthcare reimbursement.

· Proficiency in medical coding and clinical documentation improvement.

· Excellent communication, interpersonal, and teamwork skills.

· Ability to work independently and make sound clinical and financial decisions.

· Strong analytical and problem-solving skills.

· Proficient in using healthcare information systems and technology.

· Commitment to maintaining patient confidentiality and ethical standards.

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