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Hospital Utilization Management information

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$89.5K

$163K

How much do hospital utilization management jobs pay per year?

As of Sep 9, 2026, the average yearly pay for hospital utilization management in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What are popular job titles related to Hospital Utilization Management jobs?

For Hospital Utilization Management jobs, the most frequently searched job titles are:

Director, Hospital Case Management & Utilization

Worcester, MA • On-site

Central Business Solutions, Inc
See more jobs at Central Business Solutions, Incexternal

$150 - $200/hr

Other

Posted 15 days ago

Job description

Director of Case Management, Worcester, MA - (IK)
  • Worcester, Massachusetts

The individual in this position has overall responsibility for hospital utilization management, transition management, and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all state and federal regulations related to case management services. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction; Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care; Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy; and Education provided to physicians, patients, families, and caregivers

Responsibilities:

  • Manage department operations to assure effective throughput and reimbursement for services provided
  • Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
  • Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy
  • Ensure timely and effective patient transition and planning to support efficient patient throughput
  • develop and provide physician education and feedback on hospital utilization
  • other duties as assigned.
Qualifications:
  • Required:
    • Education: Bachelor's degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW
    • Experience: 3 years of acute hospital case management or healthcare leadership experience
  • Licensure/Certification:
    • Registered Nurse or LCSW/LMSW license.
    • Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy.
    • Active RN or LCSW/LMSW license for state(s) covered.
  • Preferred:
    • Experience: 5 years of acute hospital case management leadership multi-site experience
    • Education: MSN, MBA, MSW, or MHA
    • Licensure/Certification: Accredited Case Manager (ACM)

Compensation
Base Salary -USD $119,000 to $183,000
Full-time
Benefits -Full
Relocation Assistance Available -Possible for ideal candidate
Interview Travel Reimbursed -Yes
Candidate Details
Seniority Level -Director
Management Experience Required -Yes
Minimum Education -Bachelor's Degree
Screening Questions You must answer while applying
Do you have at least 3 years of hospital (acute care) case management experience?
Do you hold an active nursing or social worker license?

Central Business Solutions, Inc(A Certified Minority Owned Organization)

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Central Business Solutions, Inc

37600 Central Court Suite 214 Newark CA, 94560

Phone: (833)247-8800 Fax: (510)-740-3677

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