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Manager Utilization Management Jobs in Meridian, ID

BPA Health Inc

Clinical Director

Boise, ID · On-site

$76K - $103K/yr

Utilization Management * Provide behavioral health consultation for UM. * Review behavioral health criteria. * Monitor consistency of behavioral health decisions. * Support appeals analysis and ...

BPA Health Inc

Clinical Director

Boise, ID · On-site

$76K - $103K/yr

Utilization Management • Provide behavioral health consultation for UM. • Review behavioral health criteria. • Monitor consistency of behavioral health decisions. • Support appeals analysis ...

Pharmacy Careers

Formulary Management Pharmacist

Meridian, ID · On-site

$56.50 - $67.75/hr

Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...

Pharmacy Careers

Formulary Management Pharmacist

Boise, ID · On-site

$55.50 - $66.50/hr

Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...

Trinityhealth

Clinical Resource Manager

Boise, ID · On-site

$61K - $85K/yr

Provides hospital case management/utilization review and discharge planningcollaboratively determining level of care needs beyond acute care, providing decision support to patients/families and ...

Trinity Health

Clinical Resource Manager

Boise, ID · On-site

$61K - $85K/yr

Provides hospital case management/utilization review and discharge planningcollaboratively determining level of care needs beyond acute care, providing decision support to patients/families and ...

Trinity Health

Clinical Resource Manager

Boise, ID · On-site

$61K - $85K/yr

Provides hospital case management/utilization review and discharge planning collaboratively determining level of care needs beyond acute care, providing decision support to patients/families and ...

Evolent

Field Medical Director, Vascular Surgeon

Boise, ID · On-site

$130 - $140/hr

As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...

Evolent

Physician Reviewer-Radiology (Full-Time)

Boise, ID · On-site

$95 - $96/hr

As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy ...

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Showing results 21-40

All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Meridian, ID

Manager Utilization Management information

See Meridian, ID salary details

$37.8K

$88.2K

$162.4K

How much do manager utilization management jobs pay per year?

As of Aug 20, 2026, the average yearly pay for manager utilization management in Meridian, ID is $88,229.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,700.00 and $106,200.00 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?

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.

What are popular job titles related to Manager Utilization Management jobs in Meridian, ID?

For Manager Utilization Management jobs in Meridian, ID, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Meridian, ID look for?

The top searched job categories for Manager Utilization Management jobs in Meridian, ID are:

What cities near Meridian, ID are hiring for Manager Utilization Management jobs?

Cities near Meridian, ID with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Meridian, ID as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 100% In-person job distribution, with an average salary of $88,229 per year, or $42.4 per hour.

Clinical Director

BPA Health Inc

Boise, ID • On-site

$76K - $103K/yr

Full-time

Posted 10 days ago

Job description

Description:About BPA Health

At BPA Health, we believe that how we accomplish our work is just as important as what we accomplish. Our culture is grounded in four Core Values: Growth Mindset, Actively Engage, Do the Right Thing, and Do What You Say. These values shape the way we lead, collaborate, solve problems, and serve our clients, providers, and the individuals who rely on us every day.

BPA Health operates on the Entrepreneurial Operating System® (EOS®), creating clarity, accountability, and alignment throughout the organization. Leaders thrive by embracing ownership of their outcomes, working collaboratively across teams, addressing issues at their root cause, and continually improving the way we serve. Success is measured not only by results, but by achieving those results in a way that reflects our Vision, Core Values, and commitment to exceptional care and service.


Position Summary

The Clinical Director serves as the organization's senior behavioral health clinical leader and provides strategic clinical governance across the organization. The position provides leadership for clinical quality, provider credentialing oversight, behavioral health utilization management consultation, evidence-based practice, clinical risk management, quality improvement, and innovation. This is a strategic leadership role rather than a direct patient-care role and collaborates with the Medical Director, executive leadership, Quality Management, Credentialing, Utilization Management, and Network Management to maintain compliance with NCQA standards, contractual obligations, and applicable regulations.


Clinical Standards & Quality

•Establish behavioral health clinical standards.

•Approve clinical policies within delegated authority.

•Promote evidence-based practices.

•Support Quality Management.


Provider Credentialing Oversight

•Provide clinical oversight of behavioral health credentialing.

•Chair the Credentialing Committee.

•Review credentialing exceptions requiring clinical judgment.

•Collaborate with the Medical Director on physician credentialing and complex cases.


Utilization Management

•Provide behavioral health consultation for UM.

•Review behavioral health criteria.

•Monitor consistency of behavioral health decisions.

•Support appeals analysis and improvement.


Clinical Risk & Quality

•Review significant incidents.

•Participate in Quality and FWA activities.

•Recommend corrective actions.

•Escalate significant risks.


Clinical Innovation & Outcomes

•Evaluate emerging practices.

•Recommend new clinical models.

•Review outcomes and benchmarks.

•Support strategic planning.


Clinical Consultation & Representation

•Serve as senior behavioral health advisor.

•Consult on complex provider and operational issues.

•Represent the organization during external surveys, reviews and presentation.


Organizational Authority

•Approve behavioral health clinical policies within delegated authority.

•Recommend credentialing actions for behavioral health practitioners.

•Require review of clinical quality concerns.

•Escalate significant clinical risks to executive leadership.

•Serve on or chair designated clinical committees.


Relationship to Medical Director

The Clinical Director provides behavioral health clinical leadership and organizational clinical governance. Responsibilities requiring physician judgment remain the responsibility of the Medical Director or another appropriately qualified physician. The Clinical Director collaborates with the Medical Director on credentialing, utilization management, quality management, and clinical policy.


Requirements:

Qualifications

•Doctoral degree in an appropriate behavioral health discipline.

•Current unrestricted professional license in Idaho.

•Behavioral health leadership experience.

•Knowledge of NCQA, credentialing, utilization management, quality management, and ASAM Criteria.

•Managed behavioral health, EAP, SUD, or ASO experience preferred.