Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Director Utilization Mgmt
Lemoyne, PA · On-site
Overview The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within their assigned ...
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Director Utilization Mgmt
Lemoyne, PA · On-site
Overview The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within their assigned ...
RN - Utilization Management Quality Review Location: Remote; candidates must reside in the Tri-State area Licensure: Active Pennsylvania RN license required Position Summary The RN is responsible for ...
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RN - Utilization Management Quality Review Location: Remote; candidates must reside in the Tri-State area Licensure: Active Pennsylvania RN license required Position Summary The RN is responsible for ...
New
Clinical liaison for discharge planning with direct communication and involvement with patients/families, providers, social service discharge planners, Utilization Management team, and clinical ...
Clinical liaison for discharge planning with direct communication and involvement with patients/families, providers, social service discharge planners, Utilization Management team, and clinical ...
Clinical liaison for discharge planning with direct communication and involvement with patients/families, providers, social service discharge planners, Utilization Management team, and clinical ...
Clinical liaison for discharge planning with direct communication and involvement with patients/families, providers, social service discharge planners, Utilization Management team, and clinical ...
Clinical liaison for discharge planning with direct communication and involvement with patients/families, providers, social service discharge planners, Utilization Management team, and clinical ...
Clinical liaison for discharge planning with direct communication and involvement with patients/families, providers, social service discharge planners, Utilization Management team, and clinical ...
Role Overview Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and ...
Role Overview Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and ...
The Utilization Management Tech functions under the direction of the Supervisor to coordinate, generate and track both incoming and outgoing correspondence, faxes and authorizations related to ...
The Utilization Management Tech functions under the direction of the Supervisor to coordinate, generate and track both incoming and outgoing correspondence, faxes and authorizations related to ...
This role is responsible for performing utilization management reviews to determine the medical necessity of requested healthcare services, ensuring members receive appropriate, evidence-based care ...
This role is responsible for performing utilization management reviews to determine the medical necessity of requested healthcare services, ensuring members receive appropriate, evidence-based care ...
Director Utilization Mgmt
Lemoyne, PA · On-site
$199K - $249K/yr
How you make a difference The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives ...
Director Utilization Mgmt
Lemoyne, PA · On-site
$199K - $249K/yr
How you make a difference The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives ...
A Brief Overview Utilization Management Nurse provides comprehensive assessment, coordination ... Inform the case manager of any issues or plans noted in the documentation. * Self-Pay cases should ...
A Brief Overview Utilization Management Nurse provides comprehensive assessment, coordination ... Inform the case manager of any issues or plans noted in the documentation. * Self-Pay cases should ...
Utilization Management Compliance Nurse
Philadelphia, PA · On-site
$40 - $45.12/hr
Pennsylvania As a Utilization Management Compliance Nurse you will: * Assesses regulations and standards (NCQA, CMS and State) and assures appropriate controls are in place, making recommendations ...
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Utilization Management Compliance Nurse
Philadelphia, PA · On-site
$40 - $45.12/hr
Pennsylvania As a Utilization Management Compliance Nurse you will: * Assesses regulations and standards (NCQA, CMS and State) and assures appropriate controls are in place, making recommendations ...
New
Utilization Management Nurse RN
Broomall, PA · On-site
$60K - $107K/yr
Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...
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Utilization Management Nurse RN
Broomall, PA · On-site
$60K - $107K/yr
Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...
New
Utilization Management Nurse Consultant
Home, PA · On-site
$29.10 - $62.32/hr
Registered Nurse (RN) - Utilization Management Remote | Afternoon/Evening Shifts Available | 24/7 Operations Are you an experienced RN looking to bring your clinical expertise to a fast-paced ...
Utilization Management Nurse Consultant
Home, PA · On-site
$29.10 - $62.32/hr
Registered Nurse (RN) - Utilization Management Remote | Afternoon/Evening Shifts Available | 24/7 Operations Are you an experienced RN looking to bring your clinical expertise to a fast-paced ...
Utilization Management Nurse Consultant
Harrisburg, PA · On-site
$29.10 - $62.32/hr
Registered Nurse (RN) - Utilization Management Remote | Afternoon/Evening Shifts Available | 24/7 Operations Are you an experienced RN looking to bring your clinical expertise to a fast-paced ...
Utilization Management Nurse Consultant
Harrisburg, PA · On-site
$29.10 - $62.32/hr
Registered Nurse (RN) - Utilization Management Remote | Afternoon/Evening Shifts Available | 24/7 Operations Are you an experienced RN looking to bring your clinical expertise to a fast-paced ...
Utilization Management Coordinator - Philadelphia
Philadelphia, PA · On-site
$28 - $35/hr
Malvern Treatment Centers is currently seeking a full time Utilization Management Coordinator for our location in Philadelphia! This position is a full time, benefit eligible position and reports to ...
Utilization Management Coordinator - Philadelphia
Philadelphia, PA · On-site
$28 - $35/hr
Malvern Treatment Centers is currently seeking a full time Utilization Management Coordinator for our location in Philadelphia! This position is a full time, benefit eligible position and reports to ...
Manager Utilization Management information
See Pennsylvania salary details
$39.1K - $50.8K
9% of jobs
$59.4K is the 25th percentile. Wages below this are outliers.
$50.8K - $62.5K
22% of jobs
$62.5K - $74.2K
11% of jobs
The median wage is $81.4K / yr.
$74.2K - $85.9K
14% of jobs
$85.9K - $97.6K
12% of jobs
$105K is the 75th percentile. Wages above this are outliers.
$97.6K - $109.4K
13% of jobs
$109.4K - $121.1K
13% of jobs
$121.1K - $132.8K
5% of jobs
$132.8K - $144.5K
2% of jobs
$144.5K - $156.2K
0% of jobs
$156.2K - $167.9K
0% of jobs
$39.1K
$91.2K
$167.9K
How much do manager utilization management jobs pay per year?
As of Aug 21, 2026, the average yearly pay for manager utilization management in Pennsylvania is $91,230.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,600.00 and $109,800.00 per year, depending on experience, location, and employer.
What does a manager 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 are the key skills and qualifications needed to thrive as a manager utilization management?
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 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 is the difference between Manager Utilization Management vs Utilization Review Nurse?
| Aspect | Manager Utilization Management | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, often with management or utilization review certifications | RN, with certifications in utilization review or case management |
| Work Environment | Supervises teams, manages policies, oversees utilization review processes | Performs patient chart reviews, assesses medical necessity, collaborates with providers |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare organizations |
| Search & Comparison Intent | Yes | Yes |
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.
What are the most commonly searched types of Utilization Management jobs in Pennsylvania?
The most popular types of Utilization Management jobs in Pennsylvania are:
What are popular job titles related to Manager Utilization Management jobs in Pennsylvania?
For Manager Utilization Management jobs in Pennsylvania, the most frequently searched job titles are:
- Telephonic Nurse Case Manager
- Rn Case Management No Experience
- Rn Utilization Management
- Utilization Management Nurse Consultant
- Evening Optum Health Utilization Review
- Registered Nurse No Weekends No Holidays
- Rn Ccm
- Online Health Information Management Faculty
- Hedis Registered Nurse
- Flexible Utilization Review Nurse
What job categories do people searching Manager Utilization Management jobs in Pennsylvania look for?
The top searched job categories for Manager Utilization Management jobs in Pennsylvania are:
What cities in Pennsylvania are hiring for Manager Utilization Management jobs?
Cities in Pennsylvania with the most Manager Utilization Management job openings:
Other
Posted 22 days ago
St. Clair Health rating
6.8
Based on 31 frontline employees who took The Breakroom Quiz
498th of 891 rated healthcare providers
Job description
Summary
Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points of entry to St. Clair Hospital, and ensures that appropriate orders are placed in the electronic medical record.
Minimum Qualifications
Preferred Qualifications
Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points of entry to St. Clair Hospital, and ensures that appropriate orders are placed in the electronic medical record.
Minimum Qualifications
- Current licensure as a Registered Nurse in Pennsylvania.
- Five years of clinical experience as a Registered Nurse in an acute care setting.
- Two years of experience in Utilization Review.
- Highly effective communication skills.
- Ability to identify appropriate status and physician orders for the level of care the patient is or will be placed in.
- Ability to navigate electronic medical records and web-based applications.
- Possesses the ability to manage multiple tasks in a fast-paced environment.
Preferred Qualifications
- Bachelor's degree in nursing or health related field.
- Certification in Case Management.
What St. Clair Health employees say
Pay
Benefits
Hours and flexibility
Workplace
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About St. Clair Health
Sourced by ZipRecruiter
St. Clair Hospital is a highly honored, independent, 329 bed acute-care medical center that provides advanced, high quality health care to the residents of southwestern Pennsylvania. A member of the Mayo Clinic Care Network, St. Clair has 600 physicians and 2,500 employees. St. Clair Hospital is the largest employer in Pittsburgh’s South Hills. Providing virtually every health care service that residents may need throughout their lives, the Hospital is focused on continuously enhancing its services and technologies to ensure that the community’s health needs are met. The Hospital offers a comprehensive array of high-quality inpatient and outpatient services, including advanced cardiovascular services; specialized care for women and children; oncology services; orthopedics; emergency care; urgent care; and psychiatry and mental health services.
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Pittsburgh, PA, US
Year founded
1954