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How much do anthem utilization management jobs pay per hour?

As of Jun 9, 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

Clinical Reimbursement Coordinator, RN

Laconia Rehabilitation Center

Laconia, NH • On-site

$31 - $48/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Overview:
At Genesis Healthcare, we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fostering a collaborative, inclusive and supportive work environment where every team member is valued and empowered to make a difference. Whether you're an experienced professional or just starting your career, we offer opportunities for growth, development, and advancement in a range of roles. Join us in our mission to enhance the well-being of our patients and residents while making a meaningful impact in the communities we serve.
Responsibilities:
The MDS Nurse -- RN manages the overall process and tracking of all Medicare/Medicaid case-mix documents to ensure appropriate reimbursement for all services provided within the nursing.
 
*Maintain an accurate schedule of all MDS assessments to include the proper reference dates throughout the patient stay and ensures the accurate and timely submission of the MDS assessments including case-mix, OBRA and OSRA required assessments.
*Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture of appropriate clinical information and in this process identify opportunities to enhance reimbursement.
*Communicate case-mix data required for billing to the Business Office such as RUGs categories, modifiers, state case-mix scores, etc.
*Serve as the nursing center resource for MDS/RUGs and state case-mix systems providing staff case-mix education and instruction on MDS terminology and format.
Qualifications:

*Must be a graduate of an accredited School of Nursing with current RN licensure in the state in which employment occurs is required.

*One year of long term care clinical nursing experience is required.

*Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and/or case management is highly desirable.

*Must maintain current BLS/CPR certification (excluding ALFs/ILFs).

Benefits:

*Variable compensation plans
*Tuition, Travel, and Wireless Service Discounts
*Employee Assistance Program to support mental health
*Employee Foundation to financially assist through unforeseen hardships
*Health, Dental, Vision, Company-paid life insurance, 401K, Paid Time Off

*Free 24/7 virtual health care provided by licensed doctors for all Anthem medically-enrolled employees and their immediate family members

*On-Demand Pay Program that allows for instant access to a portion of the money you’ve already earned

We also offer several voluntary insurances such as:
*Pet Insurance
*Term and Whole Life Insurance
*Short-term Disability
*Hospital Indemnity
*Personal Accident
*Critical Illness
*Cancer Coverage

Restrictions apply based on collective bargaining agreements, applicable state law and factors such as pay classification, job grade, location, and length of service.

Posted Salary Range: USD $31.00 - USD $48.00 /Hr.

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