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Manager Utilization Management Jobs in Miami, FL

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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 21, 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 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 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 August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% In-person job distribution, with an average salary of $87,047 per year, or $41.8 per hour.

Utilization Management Representative I - Backoffice Support

Elevance Health

Miami, FL • On-site

$16.25 - $20.75/hr

Other

Posted yesterday

New

Elevance Health rating

7.6

Company rating: 7.6 out of 10

Based on 352 frontline employees who took The Breakroom Quiz

212th of 311 rated insurance

Job description

Utilization Management Representative I – Backoffice Support

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

Hours: Monday through Friday. Candidates must be available to work an assigned shift between 8:00 a.m. and 8:00 p.m. Eastern Time, based on business needs.

The Behavioral Health Utilization Management Representative I – Backoffice Support is responsible for processing precertification, prior authorization, and post-service requests for governmental and commercial lines of business. This is primarily a back of office role with no inbound call responsibilities. Limited outbound calls may be required to obtain information or support case resolution.

How you will make an impact:

  • Reviews and processes utilization management requests received through fax, electronic queues, and other approved channels.
  • Accurately enters referral and authorization information into utilization management systems.
  • Prepares and sends clear, complete, and accurate fax correspondence to providers, facilities, members, and internal partners.
  • Meets departmental productivity, quality, accuracy, and turnaround-time standards while maintaining a low error rate.
  • Reviews documentation for completeness and refers cases requiring clinical review to the appropriate clinical reviewer.
  • Verifies benefits and administrative requirements within the scope of the role.
  • Documents all actions and correspondence accurately and completely.
  • Demonstrates accountability and ownership of assigned workload by monitoring queues, prioritizing tasks, following work through completion, and escalating barriers promptly.
  • Protects confidential information and complies with HIPAA, privacy and security requirements, company policies, accreditation standards, contractual obligations, and applicable federal and state regulations.
  • Identifies and reports potential quality, privacy, compliance, or regulatory concerns through established escalation processes.
  • Performs other duties as assigned.

Minimum Qualifications:

  • Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Administrative support, healthcare operations, data entry, document processing, or back-office experience strongly preferred
  • Medical terminology training and experience in medical or insurance field preferred
  • For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  • Ability to meet established productivity, quality, accuracy, compliance, and turnaround-time expectations preferred
  • Ability to manage assigned work independently, maintain confidentiality, and follow detailed policies and procedures preferred
  • Proficiency with computers, electronic work queues, email, and document-management systems preferred
  • Experience processing faxes, referrals, authorizations, claims, medical records, or healthcare correspondence preferred
  • Knowledge of HIPAA and healthcare privacy requirements preferred
  • Experience working in a high-volume, production-based, compliance-focused environment preferred

Job Level: Non-Management Non-Exempt

What Elevance Health employees say

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Hours and flexibility

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

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