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Manager Utilization Management Jobs in Mount Laurel, NJ

IntePros

Utilization Management RN

Philadelphia, PA · On-site

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 ...

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Manager Utilization Management information

See Mount Laurel, NJ salary details

$38.6K

$90.1K

$165.9K

How much do manager utilization management jobs pay per year?

As of Sep 2, 2026, the average yearly pay for manager utilization management in Mount Laurel, NJ is $90,131.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,900.00 and $108,400.00 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 Mount Laurel, NJ?

The most popular types of Utilization Management jobs in Mount Laurel, NJ are:

What job categories do people searching Manager Utilization Management jobs in Mount Laurel, NJ look for?

The top searched job categories for Manager Utilization Management jobs in Mount Laurel, NJ are:

What cities near Mount Laurel, NJ are hiring for Manager Utilization Management jobs?

Cities near Mount Laurel, NJ with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Mount Laurel, NJ as of August 2026, with employment types broken down into 84% Full Time, and 16% Contract. Highlights an 100% In-person job distribution, with an average salary of $90,131 per year, or $43.3 per hour.

Utilization Management RN

IntePros

Philadelphia, PA • On-site

Other

Re-posted 23 days ago

Job description

PA RN License Required


We are seeking an experienced Care Management Coordinator to join our Infusion Therapy team. 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 while maintaining compliance with regulatory and accreditation standards.

This position is ideal for a clinically strong RN who thrives in a collaborative environment, enjoys critical thinking, and is passionate about improving patient outcomes through high-quality utilization management.


Key Responsibilities

  • Conduct medical necessity reviews for infusion therapy services using InterQual, medical policies, and evidence-based clinical guidelines.
  • Review medical records, treatment plans, and clinical documentation to authorize medically necessary services.
  • Collaborate with physicians and providers to obtain additional clinical information and clarify treatment plans when needed.
  • Present cases that do not meet medical necessity criteria to the Medical Director for final determination.
  • Identify discharge planning needs and collaborate with case management to support appropriate transitions of care.
  • Ensure authorization decisions comply with federal, state, and accreditation requirements while meeting established turnaround times.
  • Identify utilization trends, quality concerns, and opportunities for process improvement.
  • Accurately document all clinical reviews and maintain the integrity of care management systems.
  • Serve as a clinical resource and advocate for members navigating the healthcare system.


Qualifications

  • Active Pennsylvania Registered Nurse (RN) license required.
  • Previous experience in Utilization Management, Care Management, Case Management, or Prior Authorization.
  • Strong understanding of medical necessity review, healthcare regulations, and evidence-based clinical criteria.
  • Experience utilizing InterQual or similar medical necessity guidelines strongly preferred.
  • Excellent critical thinking, clinical assessment, communication, and documentation skills.
  • Ability to independently prioritize a high-volume workload while meeting regulatory turnaround times.


Preferred Experience

  • Managed care, health plan, or payer experience.
  • Experience reviewing inpatient, outpatient, or specialty service authorizations.


This is an excellent opportunity for an experienced RN who enjoys combining clinical expertise with analytical decision-making to ensure members receive timely, appropriate, and high-quality care while supporting organizational quality and compliance

initiatives.

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