ZipRecruiter

Log In

1

Utilization Review Manager Jobs (NOW HIRING)

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... cycle management professionals specializing in the substance use disorder, mental health, and ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Harahan, LA · On-site

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 ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Harahan, LA · On-site

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 ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing ... Proven time management skills with the ability to meet deadlines consistently * Proficiency in ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Radcliff, KY · On-site

... Utilization Review Director Job Requirements: * Current license to practice nursing in Kentucky (RN or LPN) OR * Bachelor's Degree in Social Work or Psychology * Experience in Utilization Management ...

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

Manage a caseload of 50-75 patients and authorize 15-25 cases daily, ensuring timely utilization reviews and appropriate level of care. * Verify insurance benefits , coordinate authorizations, and ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... cycle management professionals specializing in the substance use disorder, mental health, and ...

next page

Showing results 1-20

All JobsUtilization Review Manager Jobs

Utilization Review Manager information

See salary details

$39K

$91K

$167.5K

How much do utilization review manager jobs pay per year?

As of Jun 15, 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 jobs pay $2000 a day?

Utilization Review Managers typically do not earn $2000 a day; such high daily rates are more common in specialized consulting, executive roles, or highly paid medical professionals. Most jobs with daily earnings of this level require extensive experience, certifications, or work in high-demand industries like finance, law, or executive management.

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 job makes $10,000 a month without a degree?

A Utilization Review Manager can potentially earn around $10,000 per month, especially with extensive experience and certifications in healthcare management or medical review. These roles typically require strong analytical skills, knowledge of medical billing and coding, and the ability to oversee utilization review processes in healthcare settings. While a degree can be helpful, some professionals advance through experience and industry certifications such as Certified Professional in Healthcare Quality (CPHQ).

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 jobs in the US pay 300,000 a year?

Utilization Review Managers in healthcare or insurance industries can earn around $300,000 annually with extensive experience, advanced certifications, and leadership responsibilities. High-paying roles often require strong analytical skills, knowledge of medical billing and coding, and proficiency with healthcare management software. Executive-level positions in healthcare organizations may also reach or exceed this salary level.

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 medical services to ensure they are necessary, appropriate, and cost-effective. They coordinate with healthcare providers, review patient records, and ensure compliance with insurance and regulatory standards, often using specialized software. This role requires strong analytical skills and knowledge of healthcare policies and insurance guidelines.
More about Utilization Review Manager jobs
What cities are hiring for Utilization Review Manager jobs? Cities with the most Utilization Review Manager job openings:
What are the most commonly searched types of Utilization Review jobs? The most popular types of Utilization Review jobs are:
What states have the most Utilization Review Manager jobs? States with the most job openings for Utilization Review Manager jobs include:
What job categories do people searching Utilization Review Manager jobs look for? The top searched job categories for Utilization Review Manager jobs are:
Utilization Review Manager jobs near you

Utilization Review Specialist

ICBD

Lauderdale Lakes, FL • On-site

$55K - $70K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 18 days ago

Job description

Utilization Review Specialist - Exact Billing Solutions (EBS)
Lauderdale Lakes, FL - On-site - No Remote
Salary: $55K - $70K
Who We Are
Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental health, and autism care fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies.
Part of the ICBD portfolio, Exact Billing Solutions combines entrepreneurial speed with the financial discipline of a self-funded, founder-led organization. Our growth reflects a proven ability to solve complex healthcare challenges with operational precision, scalable systems, and client-first innovation.
Recognition & Awards
Exact Billing Solutions contributes heavily to the success of the broader ICBD corporate ecosystem and benefits from the recognition awarded to other portfolio companies, including:
  • Inc. 5000 - 25th Fastest-Growing Private Company in America (2025).
  • Financial Times - #5 on "The Americas' Fastest Growing Companies."
  • EY Entrepreneur Of The Year® U.S. Overall.
  • South Florida Business Journal's Top 100 Companies.
  • Florida Trend Magazine's 500 Most Influential Business Leaders.
  • Inc. Best in Business, Health Services.

About the Role
As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources.
The UR Records Specialist will assist in reviewing and processing records to submit for authorization to the payors. This position collaborates closely with clinical teams, insurance providers, and other healthcare professionals to support efficient and effective patient care.
Key Responsibilities
  • Review and analyze clinical records, including received documentation from payors, to ensure compliance with ABA therapy best practices and insurance requirements.
  • Accurately input and maintain clinical records, authorization requests, and related documents into the electronic health records (EHR) or other relevant systems.
  • Assist in tracking and organizing all documentation for utilization reviews, ensuring that all records are complete, accurate, and accessible for audits and reviews.
  • Monitor the status of pending authorizations and document updates or changes to treatment plans in a timely manner.
  • Assist in processing and reviewing requests for treatment authorization, working with clinicians to verify that all necessary documentation is available for review.
  • Assess the appropriateness and necessity of healthcare services, ensuring they align with established guidelines and policies.
  • Work closely with interdisciplinary teams, Board Certified Behavior Analysts, Registered Behavior Technicians, and other healthcare professionals to gather insights and ensure comprehensive reviews.
  • Assist in preparing records and documentation for external audits or insurance company reviews, ensuring that all necessary information is submitted and compliant with guidelines.
  • Identify any discrepancies, missing documentation, or areas where clinical records may require updates to meet the standards.
  • Assist in coordinating with insurance providers to obtain authorization and resolve any issues related to service utilization or claims denials.
  • Provide requested documentation and supporting materials for authorization and reauthorization requests, ensuring timely submission to insurance companies.
  • Maintain records of communications with insurance companies, clinical teams, and other relevant stakeholders.
  • Analyze trends in authorization requests, approvals, and denials and provide reports or insights to management to identify areas for process improvement.
  • Track utilization patterns, service delivery, and compliance with payer requirements to support continuous improvement in the utilization review process.
  • Communicate effectively with team members to ensure the smooth processing of treatment authorizations and timely updates on status or concerns.
  • Provide clear communication regarding the status of clinical record reviews, authorization requests, and insurance queries.
  • Participate in quality-improvement initiatives to enhance the overall efficiency and effectiveness of healthcare delivery.

Requirements
  • Associate's or Bachelor's degree in Healthcare Administration, Medical Records, Behavioral Health, or a related field.
  • Certification in Health Information Management (e.g., RHIA, RHIT) is a plus but not required.
  • Minimum of 1 year of experience working with clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare settings.
  • Proven experience in utilization reviews or a related field with a strong understanding of healthcare service delivery and documentation processes is highly desirable.
  • Must maintain clean background/drug screenings and driving record.

Expertise Needed
  • Familiarity with industry standards, guidelines, and best practices related to utilization review.
  • Ability to analyze complex clinical documentation, treatment plans, and medical records.
  • Strong critical thinking skills to assess the appropriateness and necessity of healthcare services.
  • Strong analytical and critical thinking skills.
  • Excellent communication and interpersonal skills.

Benefits
  • 21 paid days off (15 PTO days increasing with tenure, plus 6 paid holidays)
  • Flexible Spending Account (FSA) and Health Savings Account (HSA) options
  • Medical, dental, vision, long-term disability, life insurance, AD&D insurance, and GAP Plan (TransAmerica)
  • Generous 401(k) with up to 6% employer match
  • 100% employer-paid maternity/paternity leave for up to 5 weeks
  • Tuition reimbursement up to $2,500 per semester
  • EAP (unlimited counseling 24/7), BeyondMed (discounts on wellness and elective healthcare services), PerkSpot (discounts on top brands), Pet Insurance (Nationwide), and On the GoGa wellbeing hub

Closing Statement
Exact Billing Solutions is an Equal Opportunity Employer and is committed to building an inclusive workplace free from discrimination. We make employment decisions based on qualifications, merit, and business needs, and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law.
Exact Billing Solutions participates in the U.S. Department of Homeland Security E-Verify program.
We are committed to providing reasonable accommodation for qualified individuals with disabilities throughout the hiring process and employment. If you require assistance or accommodation, please let us know.

Apply