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Manager Utilization Management Jobs in Miami, FL

SOLIS Health Plans

Utilization Management Nurse

Miami, FL · On-site

Utilization Management Nurse Under the supervision of the Health Services Director, the Utilization ... One year experience as a case manager in a payer or facility setting highly preferred. * Discharge ...

New

Solis Health Plans

Utilization Management Nurse

Miami, FL · On-site

$60K - $70K/yr

Under the supervision of the Health Services Director, the Utilization Management Nurse (LPN or RN) ... One year experience as a case manager in a payer or facility setting highly preferred. * Discharge ...

New

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Miami, FL

Manager Utilization Management information

See Miami, FL salary details

$37.3K

$87K

$160.2K

How much do manager utilization management jobs pay per year?

As of Aug 8, 2026, the average yearly pay for manager utilization management in Miami, FL is $87,047.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,900.00 and $104,700.00 per year, depending on experience, location, and employer.

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 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 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 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 most commonly searched types of Utilization Management jobs in Miami, FL? The most popular types of Utilization Management jobs in Miami, FL are:
What are popular job titles related to Manager Utilization Management jobs in Miami, FL? For Manager Utilization Management jobs in Miami, FL, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Miami, FL look for? The top searched job categories for Manager Utilization Management jobs in Miami, FL are:
What cities near Miami, FL are hiring for Manager Utilization Management jobs? Cities near Miami, FL with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Miami, FL as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $87,047 per year, or $41.8 per hour.

Manager, Utilization Management

Independent Living Systems

Miami, FL • On-site

Full-time

Posted 4 days ago

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Manager, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Manager, Utilization Management plays a vital role in overseeing the evaluation and authorization of healthcare services to ensure appropriate, cost-effective care delivery. This position is responsible for overseeing the utilization management process to ensure efficient and effective use of resources. The Manager, Utilization Management is also responsible for developing and implementing utilization management policies and procedures to ensure compliance with regulatory requirements and industry standards. The Manager, Utilization Management will lead a team of utilization management personnel to review and authorize medical services, ensuring that they are medically necessary and appropriate. The Manager, Utilization Management’s role is vital in ensuring that patients receive the highest quality of care while managing costs for the organization.

Minimum Qualifications:

  • Bachelor's degree in nursing, healthcare administration, or related field
  • 3 years of experience in utilization management or related field
  • Experience leading a team of utilization management professionals
  • Strong knowledge of regulatory requirements and industry standards
  • Relevant experience may substitute for the educational requirement on a year-for-year basis

Preferred Qualifications:

  • Master's degree in nursing, healthcare administration, or related field
  • Experience working in a managed care organization
  • Certification in utilization management or related field

Responsibilities:

  • Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
  • Lead and manage a team of utilization management personnel to review and authorize medical services, ensuring that they are medically necessary and appropriate.
  • Manage utilization management processes to ensure efficient and effective use of resources.
  • Utilize established utilization management guidelines to review and authorize medical services.
  • Ensure that medical services are medically necessary and appropriate.
  • Implement utilization management activities in accordance with established policies and procedures.
  • Ensure compliance with regulatory requirements and industry standards.
  • Perform other duties as assigned.


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