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Kaiser Utilization Management Jobs (NOW HIRING)

Kaiser Permanente

RN, Specialty Care Review

Atlanta, GA · On-site

$40.35/hr

... that affect managed care and case/utilization management. Maintains effective interaction ... Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of ...

Kaiser Permanente

Medical Social Worker II

Vacaville, CA · On-site

$60.58/hr

Determines application of Kaiser, Medicare and Medi-Cal benefits to specific patient situations. * Participates in Utilization Management/Quality Assurance activities. * Assist in coordinating ...

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Kaiser Utilization Management information

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$39K

$89.5K

$163K

How much do kaiser utilization management jobs pay per year?

As of Jul 24, 2026, the average yearly pay for kaiser 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 is the difference between Kaiser Utilization Management vs Kaiser Case Manager?

AspectKaiser Utilization ManagementKaiser Case Manager
Primary RoleReview and authorize healthcare services based on medical necessityCoordinate and manage patient care plans and services
CertificationsTypically requires medical or nursing credentials, possibly certifications in utilization reviewOften requires nursing or social work credentials, with case management certifications
Work EnvironmentUtilization review departments within health plans or hospitalsDirect patient interaction, care coordination teams, healthcare facilities
Industry UsageCommonly employed by health insurance providers like KaiserEmployed in healthcare settings, insurance companies, or integrated health systems

While both roles are integral to healthcare management at Kaiser, Utilization Management focuses on reviewing services for appropriateness, whereas Case Managers actively coordinate patient care and services. Understanding these differences helps clarify career paths and job expectations within Kaiser’s healthcare system.

What is Kaiser Utilization Management?

Kaiser Utilization Management refers to the process within Kaiser Permanente that evaluates the necessity, appropriateness, and efficiency of healthcare services provided to members. Utilization management professionals review medical cases to ensure that treatments and procedures are medically necessary and align with established guidelines. Their goal is to optimize healthcare outcomes while controlling costs and preventing unnecessary services, ensuring members receive the right care at the right time.

How does a Kaiser Utilization Management professional typically collaborate with healthcare providers to ensure appropriate patient care?

Kaiser Utilization Management professionals work closely with physicians, nurses, and other healthcare team members to review patient cases and ensure that treatments and services are medically necessary and align with organizational guidelines. This collaboration often involves case discussions, care planning meetings, and providing recommendations for alternative care options when appropriate. Open communication and a collaborative approach help ensure patients receive high-quality care while also managing resources efficiently. Professionals in this role regularly interact with both clinical and administrative staff to resolve issues and support optimal patient outcomes.

What are the key skills and qualifications needed to thrive as a Kaiser Utilization Management professional, and why are they important?

To thrive in Kaiser Utilization Management, you need a solid background in clinical healthcare (often as an RN or other licensed clinician), understanding of medical necessity criteria, and experience with healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and knowledge of guidelines such as Milliman or InterQual are typically required. Excellent communication, critical thinking, and organizational skills set standout professionals apart in this role. These competencies ensure effective resource management, regulatory compliance, and quality patient care within the healthcare system.
More about Kaiser Utilization Management jobs
What cities are hiring for Kaiser Utilization Management jobs? Cities with the most Kaiser Utilization Management job openings:
What states have the most Kaiser Utilization Management jobs? States with the most job openings for Kaiser Utilization Management jobs include:
What job categories do people searching Kaiser Utilization Management jobs look for? The top searched job categories for Kaiser Utilization Management jobs are:
Kaiser Utilization Management jobs near you
Infographic showing various Kaiser Utilization Management job openings in the United States as of July 2026, with employment types broken down into 1% Locum Tenens, 74% Full Time, 18% Part Time, 1% Temporary, 1% Contract, and 5% Summer. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.
Lead RN Utilization Management

Lead RN Utilization Management

Kaiser Permanente

Atlanta, GA • On-site

$44.14/hr

Full-time

Posted 6 days ago

Job description

Job Summary:

Kaiser Permanente nurses are guided by an integrated nursing model that places patients and families in the center.  The Lead RN coordinates activities of the interdisciplinary team and monitors departmental throughput to ensure the delivery of high quality, safe, effective, and efficient care. Serves as a subject matter expert and resource for clinical teams on departmental processes and workflows.  Demonstrates sound decision-making and the ability to be self-directed. Manages patient assignments and changes in schedule, as needed. Addresses customer concerns or complaints in a timely manner and escalates to the manager, as needed.

Essential Responsibilities:

  • Coordinates day-to-day patient care activities within the department and acts as a resource for the healthcare team, providers, and ancillary departments.
  • Acts independently to manage multiple scheduling tasks and assignments.  
  • Evaluates emergency situations and leads the nursing response to clinical emergencies.
  • Phishes the schedule daily (2-3 days in advance) for proactive planning.
  • Conducts daily equipment checks and ensures that quality controls are completed.
  • Continuous rounding within the department to ensure patient throughput and flow, assisting as needed.
  • Ensures clear communication with the healthcare team, providers, and management team using multiple avenues, including email, teams chat, and huddles.
  • Responds to inquiries from patients, providers, healthcare team, and internal/external customers and supports resolution.
  • Participates in departmental Quality Assurance activities and supports compliance with regulatory procedures and standards.
  • Serves as a preceptor, resource, and mentor for new members of the healthcare team and nursing students.
  • Participates in departmental orientation, training, and competency validation of new staff (after completion of validator training).
  • Provide at least one (1) training in-service each year.
  • May perform other duties as assigned.

Basic Qualifications:
Experience

  • Minimum two (2) years of current RN clinical experience.
  • Minimum two (2) years of clinical experience in area of specialty.
Education

  • Associates degree in nursing.
  • High School Diploma or General Education Development (GED) required.
License, Certification, Registration
  • Registered Professional Nurse License (Georgia) required at hire
  • Basic Life Support required at hire
Additional Requirements:

  • N/A
Preferred Qualifications:

  • Specialty Certification at time of hire or within 1 (one) year.
  • Bachelors (BSN) degree.

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