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Anthem Utilization Management Jobs (NOW HIRING)

Mustang Cat

VisionLink Support Specialist

Houston, TX · On-site

Ensure customers understand features including: o Health alerts o Utilization tracking o Preventive ... Strong attention to detail with effective organization and time management skills ✅ Additional ...

True Team Medical

Clinical Supervisor

Winchester, VA

$61K - $83K/yr

You will manage clinical operations, oversee staff performance, and maintain community partnerships ... Oversee case assignments for team members and monitor caseload utilization. * Provide clinical ...

True Team Medical

Clinical Supervisor

Suffolk, VA · Hybrid

$61K - $83K/yr

You will manage clinical operations, oversee staff performance, and maintain community partnerships ... Oversee case assignments for team members and monitor caseload utilization. * Provide clinical ...

ncgCARE

Clinical Supervisor (3375)

Newnan, GA · On-site

$64K - $83K/yr

Manages case assignment for team * Engages and maintains community partnerships with stakeholders ... Monitors utilization of the caseloads of assigned team members * Provides consultation for crisis ...

AMFM Healthcare

Adolescent Primary Therapist

Bonsall, CA · On-site

$72K - $96K/yr

In this role, you will manage a caseload of 6-8 adolescent clients and their families, providing ... Collaborate with the utilization review team to provide pre-certification and concurrent reviews ...

AMFM Healthcare

Adolescent Primary Therapist

Bonsall, CA · On-site

$72K - $96K/yr

In this role, you will manage a caseload of 6-8 adolescent clients and their families, providing ... Collaborate with the utilization review team to provide pre-certification and concurrent reviews ...

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Anthem Utilization Management information

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How much do anthem utilization management jobs pay per hour?

As of Jul 2, 2026, the average hourly pay for anthem utilization management in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is an Anthem Utilization Management job?

An Anthem Utilization Management job involves reviewing healthcare services to ensure they are medically necessary and cost-effective. Professionals in this role analyze patient records, apply clinical guidelines, and collaborate with providers to determine coverage. They help manage healthcare costs while ensuring patients receive appropriate care. This position typically requires a background in nursing or healthcare and familiarity with insurance policies and regulations.

What are the key skills and qualifications needed to thrive in the Anthem Utilization Management position, and why are they important?

To thrive in Anthem Utilization Management, you need a background in healthcare or nursing, strong analytical skills, and familiarity with medical terminology and insurance procedures, often evidenced by RN or LPN licensure or a relevant Bachelor's degree. Proficiency with utilization management software, electronic medical records (EMR), and knowledge of regulatory guidelines (such as CMS or NCQA) are typically required. Excellent communication, attention to detail, and problem-solving abilities are important soft skills for collaborating with providers and guiding patient care decisions. These competencies are crucial for ensuring efficient, compliant review of medical services and effective coordination across care teams.

What are some typical responsibilities and daily tasks for someone in Anthem Utilization Management?

Professionals in Anthem Utilization Management are primarily responsible for reviewing medical authorization requests, assessing the necessity and appropriateness of care based on clinical guidelines, and communicating decisions to both providers and members. Daily tasks often include analyzing patient records, collaborating with physicians and care managers, and documenting determinations in specialized software systems. You may also participate in case rounds, handle appeals, and work closely with teams to ensure consistent adherence to policies and standards. The role requires a balance of independent review and team collaboration, offering a dynamic and meaningful contribution to patient care management.

More about Anthem Utilization Management jobs
What cities are hiring for Anthem Utilization Management jobs? Cities with the most Anthem Utilization Management job openings:
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Anthem Utilization Management jobs near you
Infographic showing various Anthem Utilization Management job openings in the United States as of June 2026, with employment types broken down into 96% Full Time, and 4% Part Time. Highlights an 92% In-person, 4% Hybrid, and 4% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Director of Revenue Cycle Management

Director of Revenue Cycle Management

Silver Hill Hospital

New Canaan, CT • On-site

$175K - $210K/yr

Full-time

Posted 25 days ago

Job description

The Director of Revenue Cycle Management is the senior leader accountable for the end-to-end revenue cycle. Reporting to the Executive Director of Finance, this role owns the people, process, technology, and vendor strategy that converts clinical care into accurate, timely, and fully reimbursed revenue.
Duties/Responsibilities:
  • Build, lead, and develop high-performing Patient Accounts and Utilization Review teams, fostering a culture of patient-centered service, financial integrity, and continuous improvement.
  • Develop and execute a multi-year RCM strategy aligned with clinical growth, payer mix, and length-of-stay dynamics across hospital and residential services.
  • Own enterprise RCM KPIs and drive performance improvement across all functions.
  • Partner with Finance on monthly close, A/R reserves, bad debt methodology, and net revenue forecasting; deliver executive and board-level reporting.
  • Oversee patient access operations (pre-admission through registration), ensuring accurate data capture, insurance verification, financial counseling, and point-of-service collections.
  • Lead authorization and utilization review across all levels of care; defend level-of-care decisions and reduce denied and avoidable days.
  • Ensure record integrity, chart completion, release of information, and compliance with HIPAA and 42 CFR Part 2 requirements.
  • Direct coding and build a Clinical Documentation Improvement program to drive accuracy, compliance, and optimal reimbursement.
  • Own Charge Description Master governance, including coding, pricing, and regulatory requirements.
  • Oversee billing and claims operations, including payment posting and reimbursement processes.
  • Improve clean claim rate and first-pass yield through process improvements.
  • Lead denials, appeals, and revenue recovery efforts using data-driven insights and accountability across teams.
  • Oversee insurance follow-up, self-pay collections, payment plans, financial assistance, and bad debt placement.
  • Partner with managed care on contract strategy, modeling, negotiations, and payer performance.
  • Oversee RCM vendors, systems, and partner with IT on technology optimization (including EHR integration and automation).
  • Ensure compliance with all applicable federal and state regulations and accreditation standards; lead internal and external audits.
  • Perform other duties and responsibilities as assigned.

Required Skills/Abilities:
  • Must have the ability to function optimally in a stressful environment, and the ability to remain calm in emotionally charged situations.
  • Strong working knowledge of behavioral health and residential treatment reimbursement required.
  • Demonstrated expertise in regulatory requirements including 42 CFR Part 2, HIPAA, MHPAEA, and the No Surprises Act required.
  • Familiarity with the Connecticut payer landscape, including Anthem, Cigna, Aetna, UnitedHealthcare/Optum Behavioral Health, ConnectiCare, HUSKY Health, and TRICARE East preferred.

Education and Experience:
  • Bachelor's degree in Healthcare Administration, Business, Finance, or related field preferred.
  • Minimum of 10+ years of progressive revenue cycle experience required, including at least 5 years in leadership across revenue cycle management (RCM) functions.
  • Proven track record of measurable improvement in core RCM KPIs and leading process and/or technology change initiatives required.
  • Experience managing third-party RCM vendors and outsourced functions required.
  • Experience with Meditech and FinThrive systems preferred.
  • Prior leadership experience in a behavioral health hospital, psychiatric facility, or residential treatment/SUD provider preferred.
  • Relevant professional certifications such as CRCR, CHFP, FHFMA, RHIA, RHIT, CCS, or CPC preferred.

Physical Requirements:
  • Prolonged periods sitting at a desk and working on a computer.
  • Must be able to lift up to 15 pounds at times.

Pay Transparency:
  • Salary range: $175,000 - $210,000
  • Overtime eligible: Exempt

Silver Hill Hospital ("SHH") is fully committed to equal employment and advancement opportunities for all present employees as well as for applicants in all phases of the employment process (recruitment, hiring, assignment, conditions of employment, compensation, benefits, training, promotion, transfer, discipline and termination). Therefore, except in any cases of bona fide occupational qualification or need, SHH will act without regard to race, color, religion, national origin, age, sex, marital status, status as a protected veteran, sexual orientation, gender identity or expression, pregnancy, past/present history of mental disorder, intellectual disability, physical or learning disability, genetic information or any other characteristics protected by applicable law, (unless it is shown by supervisory personnel that a disability prevents performance of the work involved or may result in undue hardship) in all aspects of the employment process and relationship. This policy is based on the understanding that an applicant is able to handle the job requirements. Employment decisions will be based on merit, qualifications and abilities.

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