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Manager Of Utilization Management Jobs (NOW HIRING)

Onvida Health

Hospitalist job in Yuma AZ

Yuma, AZ

$123.75 - $163.25/hr

Medical Director of Utilization Management / Transfer Center DirectorOnvida Health Yuma, Arizona, United States (On-site) We are excited to share a unique physician leadership opportunity at Onvida ...

LifePath Systems

UM Manager

Plano, TX · On-site

$78K/yr

Works under the supervision of the Utilization Management Director. * Ensures consistent application of Utilization Management Guidelines. * Coordinates and leads internal and external meetings as ...

Sanford Health

RN Utilization Management

Fargo, ND

... resource management for patient care delivery across the care continuum for assigned patient ... With involvement of the patient/family, collaborates with licensed practitioners and other inter ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...

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How much do manager of utilization management jobs pay per year?

As of Jul 8, 2026, the average yearly pay for manager of utilization management in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 per year, depending on experience, location, and employer.

What is the difference between Manager Of Utilization Management vs Utilization Review Nurse?

AspectManager Of Utilization ManagementUtilization Review Nurse
CredentialsRN, sometimes with management certificationsRN, with clinical experience
Work EnvironmentAdministrative, overseeing teams and policiesClinical, performing reviews and assessments
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Primary FocusManaging utilization review processes and team supervisionConducting individual patient reviews and assessments

The main difference is that the Manager Of Utilization Management oversees the entire utilization review process and team management, while the Utilization Review Nurse focuses on performing clinical reviews of patient cases. Both roles require RN credentials and work within healthcare or insurance settings, but their responsibilities and focus areas differ significantly.

What does a utilization manager do?

A utilization manager oversees the review and authorization of healthcare services to ensure they are medically necessary and appropriate. They analyze patient records, coordinate with healthcare providers, and use utilization review tools to manage costs and quality of care within healthcare organizations.

What degree do you need for utilization management?

A manager of utilization management typically needs at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Many employers prefer candidates with a master's degree or relevant certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Strong knowledge of healthcare policies, insurance processes, and data analysis skills are also important for the role.

What is the highest paying manager position?

The highest paying manager positions often include executive roles such as Chief Operating Officer (COO), Chief Executive Officer (CEO), or Vice President, which typically offer salaries significantly higher than other management roles. In healthcare, senior management roles like Director of Utilization Management or Medical Director can also command high compensation, especially with relevant certifications and extensive experience.

What is the highest paying job in healthcare management?

In healthcare management, the highest paying roles are often executive positions such as Chief Executive Officer (CEO) or Chief Operating Officer (COO), with salaries exceeding $150,000 annually. Other high-paying roles include hospital administrators and healthcare system directors, especially those overseeing large organizations or specialized departments, often requiring advanced degrees and extensive experience.
What cities are hiring for Manager Of Utilization Management jobs? Cities with the most Manager Of Utilization Management job openings:
What are the most commonly searched types of Of Utilization Management jobs? The most popular types of Of Utilization Management jobs are:
What states have the most Manager Of Utilization Management jobs? States with the most job openings for Manager Of Utilization Management jobs include:
Manager Of Utilization Management jobs near you
Utilization Management Program Manager-RN

Utilization Management Program Manager-RN

Samaritan Health Services

Eugene, OR • On-site

Other

Re-posted yesterday

Samaritan Health Services rating

7.4

Company rating: 7.4 out of 10

Based on 64 frontline employees who took The Breakroom Quiz

260th of 880 rated healthcare providers

Job description

Summary

  • Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans. 

    As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

    This is a remote position in which we are able to employ in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin

    Our ideal candidate will have the following experience:

    •  
    • Health plan utilization management 
    • Medicare and Medicaid rules and regulations and health plan benefit structure and policy.
    • Data analysis to include reporting results and developing improvement plans
    • Quality Management experience in a healthcare setting
  • JOB SUMMARY/PURPOSE
    • Executes program(s) that meet the needs of the organization, employees and/or customers. Plans, initiates, oversees execution of all elements for assigned program(s). Leads the development, implementation and management of assigned program(s) and associated projects. Oversees process from planning to completion. Works with multiple internal teams, vendors, clients. Responsible for explaining, training, and mentoring the entire organization on the program. Collaborates with SHS system experts to ensure focus, alignment, and best practices for the program.
  •  
  • EXPERIENCE/EDUCATION/QUALIFICATIONS
    • Current unencumbered Oregon RN License required within 90 days of hire. BSN preferred. Master's degree in a related field preferred.
    • One (1) year clinical nursing experience plus four (4) years health plan utilization management experience required.
    • Experience or training in the following required:
      • Health care delivery systems and/or managed care patients.
      • Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced).
    • Experience in the following preferred: 
      • Team leadership.
      • Case management.
      • Medicare and Medicaid rules and regulations and health plan benefit structure and policy.
  • KNOWLEDGE/SKILLS/ABILITIES
    • Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
    • Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
    • Critical thinking – Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
    • Communication and team building – Lead effectively with excellent verbal and written communication. Delegates and initiates/manage cross-functional teams and multi-disciplinary projects.
  • PHYSICAL DEMANDS

    • Rarely
      (1 - 10% of the time)

      Occasionally
      (11 - 33% of the time)

      Frequently
      (34 - 66% of the time)

      Continually
      (67 – 100% of the time)

      CLIMB - STAIRS

      LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs

      LIFT (Knee to chest: 24"-54") 0 – 20 Lbs

      LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

      CARRY 1-handed, 0 - 20 pounds

      BEND FORWARD at waist

      KNEEL (on knees)

      STAND

      WALK – LEVEL SURFACE

      ROTATE TRUNK Standing

      REACH - Upward

      PUSH (0 - 20 pounds force)

      PULL (0 - 20 pounds force)

      SIT

      CARRY 2-handed, 0 - 20 pounds

      ROTATE TRUNK Sitting

      REACH - Forward

      MANUAL DEXTERITY Hands/wrists

      FINGER DEXTERITY

      PINCH Fingers

      GRASP Hand/Fist

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