Utilization Review Manager Jobs
Utilization Review Manager jobs are open across health insurance, hospital systems, and managed care organizations, with specializations in clinical denials, case management, and medical necessity review, from team lead to director level. Scan the live roles below and apply to whichever ones fit.
Find JobsLooking for remote work? View remote utilization review manager jobs →Overview
Showing 5 of 130+ Utilization Review Manager jobs
SUMMARY:
The Authorization Nurse will oversee the processing of assigned authorizations for participant care, supplies, and other related needs. This will include but not be limited to primary responsibility for Emergency Room and Hospital Admission authorizations as well as oversight of accurate completion of all other types in conjunction with clinical and supportive staff.
SPECIFIC DUTIES AND FUNCTIONS:
- Enter authorizations for participants seen in Emergency Departments and/or Admitted to the Hospital, including Observation stays; complete authorization to include all required information (i.e. discharge date, diagnosis, discharge location).
- Coordinate authorization information for all participant care needs with interdisciplinary team (IDT) members ensuring completeness of all required information.
- In tandem with Authorization Coordinator, monitor all participant authorizations in EMR for accuracy and correct information.
- Assess need and provide education to IDT staff regarding authorization processing and management to improve compliance where required.
- Recommend workflow modifications/changes to improve PACE Southeast MI authorization management in terms of both efficiency and quality.
- Audit EMR (currently TruChart) for authorization status, notifying individuals and leadership of any trends or issues relating to timeliness, error rates, or similar quality issues.
- Assign specific tasks to support audit needs and action plans to Authorization Coordinator.
- Present audit findings to key Leadership Team members on a regular basis plus as requested, participating as a member of the PACE Southeast MI Quality Improvement Team.
- Other duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
- Registered Nurse in State of MI with unencumbered license, BSN preferred;
- Minimum 2 years’ experience in a managed care environment, preferably in a utilization related role;
- Must have one year of experience with a frail, elderly population
WORK ENVIRONMENT:
- Professional office environment
- Occasional interaction with participants with risk of exposure to communicable diseases
SUMMARY:
The Authorization Nurse will oversee the processing of assigned authorizations for participant care, supplies, and other related needs. This will include but not be limited to primary responsibility for Emergency Room and Hospital Admission authorizations as well as oversight of accurate completion of all other types in conjunction with clinical and supportive staff.
SPECIFIC DUTIES AND FUNCTIONS:
- Enter authorizations for participants seen in Emergency Departments and/or Admitted to the Hospital, including Observation stays; complete authorization to include all required information (i.e. discharge date, diagnosis, discharge location).
- Coordinate authorization information for all participant care needs with interdisciplinary team (IDT) members ensuring completeness of all required information.
- In tandem with Authorization Coordinator, monitor all participant authorizations in EMR for accuracy and correct information.
- Assess need and provide education to IDT staff regarding authorization processing and management to improve compliance where required.
- Recommend workflow modifications/changes to improve PACE Southeast MI authorization management in terms of both efficiency and quality.
- Audit EMR (currently TruChart) for authorization status, notifying individuals and leadership of any trends or issues relating to timeliness, error rates, or similar quality issues.
- Assign specific tasks to support audit needs and action plans to Authorization Coordinator.
- Present audit findings to key Leadership Team members on a regular basis plus as requested, participating as a member of the PACE Southeast MI Quality Improvement Team.
- Other duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
- Registered Nurse in State of MI with unencumbered license, BSN preferred;
- Minimum 2 years’ experience in a managed care environment, preferably in a utilization related role;
- Must have one year of experience with a frail, elderly population
WORK ENVIRONMENT:
- Professional office environment
- Occasional interaction with participants with risk of exposure to communicable diseases
Utilization Review Manager Jobs by Experience Level
See All 130+ Utilization Review Manager Jobs
Find roles that match your experience and apply in just a few clicks.
Find JobsUtilization Review Manager Job Market
Who's Hiring
Top Industries Hiring
- Healthcare & Medical Services
- Insurance
- Education
- Human Resources
- Science & Research
What Employers Look For
The qualifications that appear most often in utilization review manager jobs.
- Active registered nurse (RN) or other clinical license required
- Two or more years of utilization review or case management experience
- Working knowledge of InterQual or Milliman clinical criteria
- Familiarity with Medicare, Medicaid, and commercial payer guidelines
- Experience managing or supervising a clinical review team
- Proficiency with care management platforms or utilization management software
Tips for Your Utilization Review Manager Job Search
Align your resume to clinical criteria systems
Hiring managers in this field look for direct experience with InterQual or Milliman clinical guidelines. Name the specific criteria system you used, the payer or health plan context, and whether you managed a team applying those criteria daily.
Highlight denial overturn rates concretely
Quantify your impact on appeals outcomes. Saying you led peer-to-peer review processes that reduced inappropriate denials is far stronger than listing 'utilization management' as a skill. Numbers tied to denial management get attention from hiring committees.
Apply early to roles that fit
Migrate Mate lists utilization review manager openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Target postings by payer versus provider setting
Your day-to-day responsibilities differ sharply between a commercial health plan and an acute care hospital. Filter your search by setting so your application speaks directly to that environment's regulatory pressures, staffing model, and clinical review workflows.
Prepare for scenario-based interview questions
Interviewers will ask how you handled a physician escalation or a complex concurrent review case. Prepare two or three specific examples where you balanced clinical judgment with payer contracts, regulatory requirements, and care coordination across your team.
Negotiate scope before accepting an offer
Clarify whether the role owns the appeals process end to end or hands off to a separate clinical appeals team. Mismatched expectations about team size, vendor oversight, and reporting structure are common friction points for utilization review managers in the first six months.
Utilization Review Manager Jobs: Frequently Asked Questions
Which companies are hiring the most utilization review managers?
UT Southwestern Medical Center, Providence, and MedStar Health are hiring the most utilization review managers right now, with openings concentrated in California, Texas, and Ohio, based on current listings on Migrate Mate as of November 2026. Health plans, hospital systems, and managed care organizations account for the largest share of active postings.
How many utilization review manager jobs are remote?
About 73% of utilization review manager openings are fully remote or hybrid as of November 2026, reflecting the shift toward telehealth-integrated care management models. Roles focused on prospective and concurrent review for commercial payers tend to offer the highest share of remote or hybrid arrangements compared to inpatient hospital-based positions.
How do you become a utilization review manager?
Most utilization review managers start as registered nurses or allied health clinicians, then move into staff-level utilization review roles to build hands-on experience with clinical criteria and payer authorization workflows. From there, taking on lead or supervisory responsibilities, earning a case management certification such as CCM or ACM, and gaining exposure to appeals processes positions you for a manager-level role.
Can you get a utilization review manager job with limited management experience?
Yes, some employers will hire strong clinical leads into a utilization review manager role if you can demonstrate you have informally supervised others, led quality improvement projects, or trained staff on criteria application. Framing your resume around oversight responsibilities and outcomes, even without a formal manager title, makes a real difference when you're making the step up.
What does the utilization review manager interview process look like?
Most employers run a phone screen with HR, followed by a panel interview with clinical operations leadership and sometimes a medical director. Expect scenario questions around handling denial escalations, managing staff productivity, and ensuring regulatory compliance. Some organizations include a practical component where you walk through a sample case review or explain how you would structure team workflows.
Where can I find and apply to utilization review manager jobs?
You can find and apply to utilization review manager jobs on Migrate Mate, which lists current openings from across the United States. Search for roles that match your clinical background and payer or provider experience, then apply directly to each listing that fits your situation.
See All 130+ Utilization Review Manager Jobs
Find roles that match your experience and apply in just a few clicks.
Find Jobs