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Manager Utilization Management Jobs in Philadelphia, PA

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 Philadelphia, PA salary details

$39.4K

$91.8K

$169K

How much do manager utilization management jobs pay per year?

As of Aug 31, 2026, the average yearly pay for manager utilization management in Philadelphia, PA is $91,838.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,000.00 and $110,500.00 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 Philadelphia, PA?

The most popular types of Utilization Management jobs in Philadelphia, PA are:

What are popular job titles related to Manager Utilization Management jobs in Philadelphia, PA?

For Manager Utilization Management jobs in Philadelphia, PA, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Philadelphia, PA look for?

The top searched job categories for Manager Utilization Management jobs in Philadelphia, PA are:

What cities near Philadelphia, PA are hiring for Manager Utilization Management jobs?

Cities near Philadelphia, PA with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Philadelphia, PA 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 $91,838 per year, or $44.2 per hour.

Utilization Management RN - Post Acute

Philadelphia, PA • On-site

IntePros
Software Development • 201 - 500 employees
Learn more about InteProsexternal

Other

Posted 7 days ago

Job description

Utilization Management RN
We're actively seeking qualified candidates for a Utilization Management Coordinator / RN opportunity supporting inpatient utilization management and care coordination.
This position is remote; however, candidates must reside in Pennsylvania, New Jersey, or Delaware to be eligible for potential conversion.
Key Requirements
  • Active Pennsylvania RN license required
  • Post-acute care experience required
  • Minimum of 3 years of acute-care clinical experience in a hospital or healthcare setting
  • Utilization management and/or discharge planning experience strongly preferred
  • Experience reviewing medical necessity, level of care, continued stay, and length of stay
  • Experience working with clinical criteria such as InterQual or similar tools preferred
Position Overview
The Utilization Management Coordinator / RN performs utilization management reviews for inpatient hospital admissions and works closely with providers, hospital case management teams, Medical Directors, members, and families to promote high-quality, cost-effective care.
This individual will evaluate medical necessity and continued stay, identify discharge planning needs, and help facilitate transitions to the most appropriate level and setting of care.
Responsibilities
  • Perform telephonic utilization management reviews for inpatient hospital admissions.
  • Evaluate medical necessity, appropriate level of care, continued stay, and length of stay using established clinical criteria.
  • Review treatment plans and collaborate with attending physicians and hospital utilization review teams regarding continued inpatient needs.
  • Identify admissions that no longer meet established criteria and escalate cases to Medical Directors for review.
  • Present relevant clinical information to Medical Directors regarding the member's condition, treatment plan, discharge needs, and potential home or post-acute care requirements.
  • Proactively identify hospitalized members requiring discharge planning support.
  • Collaborate with hospital case managers, physicians, members, and families to facilitate safe and timely transitions to the most appropriate setting.
  • Evaluate potential alternative levels of care and post-acute services when appropriate.
  • Refer members to Case Management and Disease Management programs when additional support is needed.
  • Identify potential quality-of-care concerns, including delays in care, and escalate appropriately.
  • Maintain timely and accurate documentation of utilization review activities and clinical determinations.
  • Ensure utilization decisions comply with applicable state, federal, and accreditation requirements.
  • Develop strong working relationships with providers while delivering a high level of customer service.
  • Identify utilization trends and potential areas for improvement and communicate findings to leadership.
  • Support provider education related to managed care and utilization management processes.
Qualifications
  • Active Pennsylvania Registered Nurse (RN) license required.
  • Minimum of 3 years of acute-care clinical experience in a hospital or healthcare environment.
  • Post-acute care experience required.
  • Previous utilization management, utilization review, concurrent review, case management, and/or discharge planning experience preferred.
  • Strong understanding of medical necessity, level-of-care determination, discharge planning, and transitions of care.
  • Excellent clinical judgment and problem-solving skills.
  • Strong written and verbal communication skills with the ability to effectively collaborate with physicians, providers, and multidisciplinary teams.
  • Highly organized with the ability to manage multiple cases and competing priorities.
  • Strong team-oriented approach and commitment to quality patient care.

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