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Utilization Review Manager Jobs (NOW HIRING)

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

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

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

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 ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

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

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

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

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 ...

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 ...

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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 Tech

Utilization Review Tech

St. Francis Medical Center

Lynwood, CA • On-site

$21 - $24.45/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 17 days ago

Job description

Overview

St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Obstetrics, Pediatrics, Behavioral Health, and Emergency and Trauma Care. In addition, the hospital offers a broad array of education and outreach programs that advance community health. St. Francis Medical Center is a Comprehensive Stroke Center, STEMI Receiving Center, ED Approved for Pediatrics, Geriatric ED, Level III Neonatal ICU, and Level II Trauma Center. Please visit www.stfrancismedicalcenter.com for more information. Join an award-winning team of dedicated professionals committed to compassion, quality, and service!

Responsibilities

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned.  The Utilization review tech will further support the department needs for Release of Information, discharge coordination or other duties as assigned.

Qualifications

Education and Work Experience

  • Minimum one year denials management experience in acute care setting highly preferred.
  • High School Diploma or equivalent required.
  • Accurate alphabetic, numeric, and/or terminal-digit filing skills.
  • Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.
  • Knowledge of terminal digit filing and medical terminology; preferred.
  • Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
  • Completion of a medical terminology course; preferred.
  • Background in business and office training; preferred.
    • Pay Transparency

    St. Francis Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time. The current compensation range for this role is $21.00 to $24.45. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

    Employment StatusFull TimeShiftDaysEqual Employment Opportunity

    Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

    Privacy Notice

    Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

    Employment Type: FULL_TIME

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