Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible ... Collaborate with clinical, admissions, billing, and case management teams to ensure continuity of ...
Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible ... Collaborate with clinical, admissions, billing, and case management teams to ensure continuity of ...
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:
UR Coordinator, Full Time
$24 - $32/hr
Experience in utilization review, case management, medical records, or healthcare billing strongly preferred * Strong understanding of insurance authorization processes (Medicare, Medicaid, and ...
UR Coordinator, Full Time
$24 - $32/hr
Experience in utilization review, case management, medical records, or healthcare billing strongly preferred * Strong understanding of insurance authorization processes (Medicare, Medicaid, and ...
Conducts utilization reviews of behavioral health cases to determine medical necessity ... management to maintain appropriate and cost-effective patient care. * Documents all case reviews ...
Conducts utilization reviews of behavioral health cases to determine medical necessity ... management to maintain appropriate and cost-effective patient care. * Documents all case reviews ...
No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past hospital experience (3-4 years of experience, less experience is ok ...
No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past hospital experience (3-4 years of experience, less experience is ok ...
RN Case Manager
Columbus, OH · On-site
Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab ... Case Management Team Lead * Assess documentation of medical records for completeness on a ...
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RN Case Manager
Columbus, OH · On-site
Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab ... Case Management Team Lead * Assess documentation of medical records for completeness on a ...
RN Case Manager
Columbus, OH · On-site
Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab ... Case Management Team Lead * Assess documentation of medical records for completeness on a ...
Quick apply
RN Case Manager
Columbus, OH · On-site
Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab ... Case Management Team Lead * Assess documentation of medical records for completeness on a ...
RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...
RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...
RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...
Quick apply
RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...
RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...
RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...
RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...
RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...
Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support ...
Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support ...
Case Manager
Westerville, OH · On-site
$19.50 - $25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications • License or ...
Case Manager
Westerville, OH · On-site
$19.50 - $25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications • License or ...
Case Manager
Westerville, OH · On-site
$19.25 - $24.75/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:
Case Manager
Westerville, OH · On-site
$19.25 - $24.75/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:
Case Manager/Social Worker - Substance Abuse Program Coordinator
$20.75 - $27.25/hr
LCDC III or LSW is acceptable if working in the Substance Abuse Program. Prefer 2 years utilization review, discharge planning, case management or medical social work experience. Strong ...
Case Manager/Social Worker - Substance Abuse Program Coordinator
$20.75 - $27.25/hr
LCDC III or LSW is acceptable if working in the Substance Abuse Program. Prefer 2 years utilization review, discharge planning, case management or medical social work experience. Strong ...
Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...
Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...
RN - Case Manager
Dublin, OH · On-site
RN - Case Manager VIBRA TRAVELS is seeking a Case Manager to join our expanding network of health ... Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment ...
New
RN - Case Manager
Dublin, OH · On-site
RN - Case Manager VIBRA TRAVELS is seeking a Case Manager to join our expanding network of health ... Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment ...
New
RN - Case Management
Dublin, OH · On-site
The Clinical Case Manager is responsible for utilization reviews, resource management, discharge planning, treatment plan management, and financial management, while also completing medical record ...
RN - Case Management
Dublin, OH · On-site
The Clinical Case Manager is responsible for utilization reviews, resource management, discharge planning, treatment plan management, and financial management, while also completing medical record ...
Lead Case Manager
Columbus, OH · On-site
Review case management metrics and quality assurance reports. * Coordinate with profiling officers during bi-monthly case reviews. * Monitor contractor performance and implement quality control ...
Lead Case Manager
Columbus, OH · On-site
Review case management metrics and quality assurance reports. * Coordinate with profiling officers during bi-monthly case reviews. * Monitor contractor performance and implement quality control ...
Utilization Review Case Manager information
See salary details
$16.59 - $20.54
3% of jobs
$20.54 - $24.50
1% of jobs
$24.50 - $28.45
6% of jobs
$30.36 is the 25th percentile. Wages below this are outliers.
$28.45 - $32.41
30% of jobs
The median wage is $33.83 / hr.
$32.41 - $36.36
26% of jobs
$37.87 is the 75th percentile. Wages above this are outliers.
$36.36 - $40.32
22% of jobs
$40.32 - $44.27
3% of jobs
$44.27 - $48.23
0% of jobs
$48.23 - $52.19
5% of jobs
$52.19 - $56.14
2% of jobs
$56.14 - $60.10
1% of jobs
$16
$36
$60
How much do utilization review case manager jobs pay per hour?
As of Jul 30, 2026, the average hourly pay for utilization review case manager in the United States is $36.49, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $38.46 per hour, depending on experience, location, and employer.
What are popular job titles related to Utilization Review Case Manager jobs? For Utilization Review Case Manager jobs, the most frequently searched job titles are:
- Registered Nurse Utilization Review
- Full Time Behavioral Health Utilization Review
- Cvs Utilization Management Nurse
- Temporary Utilization Review Nurse
- Evening Optum Health Utilization Review
- Full Time Physician Advisor Utilization Review
- No Experience Utilization Review Nurse
- Manager Utilization Management
- Temporary Admission Discharge Nurse
- Remote Cvs Utilization Management Nurse
What job categories do people searching Utilization Review Case Manager jobs look for? The top searched job categories for Utilization Review Case Manager jobs are:
What cities are hiring for Utilization Review Case Manager jobs? Cities with the most Utilization Review Case Manager job openings:
What states have the most Utilization Review Case Manager jobs? States with the most job openings for Utilization Review Case Manager jobs include:
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Job description
Position: Utilization Review Specialist
Job Summary: The Utilization Review (UR) Specialist is responsible for ensuring that clients receiving substance use disorder (SUD) treatment services meet clinical criteria for admission, continued stay, and discharge. This role supports compliance with payer requirements, maintains proper documentation, and collaborates with clinical and administrative teams to maximize reimbursement while ensuring high-quality, medically necessary care.
Reports to: VP of Revenue Cycle Management
Duties and Responsibilities:
Duties include, but are not limited to:
- Conduct initial and concurrent reviews to determine medical necessity using established criteria
- Submit authorization requests and clinical documentation to insurance providers in a timely manner
- Monitor authorizations and ensure services rendered align with approved levels of care
- Track and manage authorization expirations and initiate reauthorization requests as needed
- Review clinical records for completeness, accuracy, and compliance with payer and regulatory standards
- Ensure treatment plans, progress notes, and discharge summaries support medical necessity
- Provide feedback to clinical staff to improve documentation quality
- Maintain adherence to HIPAA and confidentiality regulations
- Serve as the primary liaison between the organization and insurance companies for utilization review matters
- Participate in peer-to-peer reviews when required
- Address denials by gathering supporting documentation and submitting appeals
- Stay current with payer guidelines and regulatory changes affecting SUD services
- Collaborate with clinical, admissions, billing, and case management teams to ensure continuity of care and proper utilization of services
- Participate in multidisciplinary team meetings to discuss patient progress and level-of-care needs
- Communicate authorization status and payer requirements to relevant staff
- Maintain accurate records of authorizations, denials, and appeals
- Track utilization metrics and identify trends to improve efficiency and reimbursement
- Participate in audits and quality assurance initiatives
- Perform other duties as assigned
Required Experience/Abilities:
- Bachelor's degree in behavioral health, nursing, social work, or a related field required.
- Knowledge of ASAM Criteria required
- Minimum of 1 year of experience in utilization review, case management, or clinical services within behavioral health or SUD treatment
- Experience working with commercial insurance, Medicaid, and/or Medicare preferred
- Familiarity with electronic health record (EHR) systems
- Must pass BCI check, all Corporate Compliance checks, and employment drug screen
Desired Experience/Abilities:
- Master's degree or clinical licensure (e.g., LSW, LPC, LCSW, RN) preferred.3 years in a supervisory or management role within a behavioral health setting
- Working knowledge of CPT and ICD-10 coding systems, with relevant certification (e.g., CPC, CCS-P) or equivalent experience
- Understanding of medical necessity criteria, including experience with InterQual and/or Milliman (MCG) guidelines
Location: Columbus, OH
About Lighthouse Behavioral Health Solutions
Sourced by ZipRecruiter
Industry
Offices of mental health practitioners
Company size
201 - 500 Employees
Headquarters location
Columbus, OH, US
Year founded
2018