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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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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Philadelphia, PA

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 Sep 5, 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 85% Full Time, and 15% Contract. Highlights an 100% In-person job distribution, with an average salary of $91,838 per year, or $44.2 per hour.

Utilization Management Supervisor

ProgenyHealth LLC

Plymouth Meeting, PA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New

Job description

Description:


Job Role

The Utilization Management Supervisor will primarily be responsible for managing the UM nursing staff in the day to day operations of the department. This includes oversight and adjustment of work queues, when needed, to maintain work flow balance; monitoring and implementing adherence to department and company metrics; training of new hires and on-going clinical; and various other responsibilities to support the clinical nursing staff and the company program. The incumbent will also be responsible for assessment of the UM program for opportunities to improve efficiencies and/or improve outcomes.


Reporting to the Director of Utilization Management, the Supervisor will work closely with the management staff and will play a key role in implementing the culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission statement: To improve the health outcomes of infants in intensive care nurseries through partnership, care facilitation, continuous quality improvement and a firm commitment to excellence.

Requirements:


Qualifications

  • Registered Nurse (RN) with a current, unrestricted license is required.
  • Two or more years of experience in Managed Care, in a Utilization Review or Case Management role, is required.
  • Experience in a team lead or supervisory role managing nursing staff is desired.
  • Three or more years of clinical experience as a bedside nurse in NICU/PICU/Peds/ICU required.
  • Must be available to stay late as needed to manage staff and caseloads.
  • Experience with URAC standards preferred.
  • Must have demonstrated strong problem-solving skills.
  • Must have proven track record of utilizing tact, diplomacy and strategic thinking in addressing issues and changes in company policy, etc.
  • Must be self-motivated and willing to learn multiple tasks.
  • Must be well organized and able to prioritize tasks.
  • Must have good computer skills and be familiar with using Microsoft Office (Word, Outlook etc)
  • Must demonstrate accuracy in spelling and documentation.
  • Must have commitment to excellence in customer service.


Benefits


Some of the benefits we offer our team are:

  • Paid Time Off
  • Paid Parental Leave
  • Medical, dental, vision benefits
  • 401K with company match
  • Short- and Long-Term Disability
  • Group Life Insurance
  • Tuition reimbursement
  • Professional development opportunities
  • Business Casual work environment
ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: careers@progenyhealth.com


All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.