ZipRecruiter

Log In

1

Manager Utilization Management Jobs (NOW HIRING)

Harris Health System

Sr Mgr-Utilization Mgmt

Houston, TX · On-site

$107.60K - $134.50K/yr

Complete other duties as assigned by the Director of Utilization Management and SVP Medical Affairs. MINIMUM QUALIFICATIONS: Education/Specialized Training/Licensure: RN required, bachelor's degree ...

next page

Showing results 1-20

People also search for

All JobsManager Utilization Management Jobs

Manager Utilization Management information

See salary details

$39K

$91K

$167.5K

How much do manager utilization management jobs pay per year?

As of May 28, 2026, the average yearly pay for manager 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 are the key skills and qualifications needed to thrive as a Manager Utilization Management, and why are they important?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a Manager in Utilization Management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a Manager of Utilization Management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

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

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

More about Manager Utilization Management jobs
What cities are hiring for Manager Utilization Management jobs? Cities with the most Manager Utilization Management job openings:
What are the most commonly searched types of Utilization Management jobs? The most popular types of Utilization Management jobs are:
What states have the most Manager Utilization Management jobs? States with the most job openings for Manager Utilization Management jobs include:
What job categories do people searching Manager Utilization Management jobs look for? The top searched job categories for Manager Utilization Management jobs are:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in the United States as of May 2026, with employment types broken down into 82% Full Time, 15% Part Time, and 3% Contract. Highlights an 38% Physical, 8% Hybrid, and 54% Remote job distribution, with an average salary of $91,011 per year, or $43.8 per hour.
Manager, Utilization Management

Manager, Utilization Management

Santa Clara Family Health Plan

San Jose, CA • On-site

$130.62K - $202.47K/yr

Full-time

Posted 12 days ago

Job description

Manager, Utilization Management
Salary Range: $130,622 - $202,465
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.
FLSA Status: Exempt
Department: Health Services
Reports To: Director of Medical Management
GENERAL DESCRIPTION OF POSITION
The Manager of Utilization Management (UM) is responsible for the direct oversight of internal and external delegated UM functions including the development and implementation of policies, procedures and program development and related quality monitoring. In addition, the Manager of UM is responsible for supervising the Supervisor of UM to ensure that all administrative UM processes are performed in accordance with all applicable state and federal regulatory requirements, SCFHP policies and procedures and business requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.
  1. Develop, implement and manage all UM processes for continuous and sustained compliance with all applicable state, federal and NCQA regulatory requirements, SCFHP policies and procedures and general business requirements for all lines of business.
  2. Develop and implement continuous analysis and quality monitoring of all policies and procedures to evaluate UM staff performance and ensure regulatory compliance, including the development and implementation of effective, measurable corrective action plans to meet targeted strategic outcomes.
  3. Ensure the integration of UM operations into other internal and external teams/departments including Quality, Long Term Services and Support (LTSS) and Behavioral Health (BH).
  4. Establish and maintain effective interpersonal relationships with all SCFHP staff, members and/or their authorized representatives, providers and other program or agency representatives.
  5. Ensure UM Committee preparedness.
  6. Attend off-site meetings.
  7. Perform other related duties as required or assigned.
SUPERVISORY/MANAGEMENT RESPONSIBILITIES
Carries out supervisory/management responsibilities in accordance with the organization's policies, procedures, applicable regulations and laws. Responsibilities include:
  1. Recruiting, interviewing, and hiring.
  2. Developing a high performing department culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives.
  3. Effectively assimilating, training and mentoring staff and (when appropriate), cross training existing staff and initiating retraining. This includes coaching to help increase skills, knowledge and (if applicable) improve performance.
  4. Setting goals and planning, assigning, and directing work consistent with said goals. This includes responding to employees' needs, ensuring they have the necessary resources to do their work.
  5. Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews.
REQUIREMENTS - Required (R) Desired (D)
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.
  1. Unrestricted professional RN licensure in the state of California. (R)
  2. Minimum two years of experience in a supervisory capacity in a managed care setting. (R)
  3. Understanding and/or experience with Utilization Management. (R)
  4. Must be knowledgeable of DHCS, CMS, DMHC regulations and NCQA regulatory Population Health standards. (R)
  5. Ability to consistently meet accuracy and timeline requirements to maintain regulatory requirements.
  6. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R)
  7. Ability to use a keyboard with moderate speed and high level of accuracy. (R)
  8. Excellent written, verbal, and interpersonal communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R)
  9. Ability to comply with all SCFHP policies and procedures. (R)
  10. Ability to think and work under pressure and effectively prioritize and complete tasks within established timeframes. (R)
  11. Ability to assume responsibility and exercise sound judgment when making decisions within the scope of this position. (R)
  12. Maintenance of a valid California Driver's License and acceptable driving record in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
PHYSICAL REQUIREMENTS
Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:
  1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
  2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
  3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
  4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
  5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
  6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)
ENVIRONMENTAL CONDITIONS
General office conditions. May be exposed to moderate noise levels. Frequent computer screen exposure.
EOE

Apply