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Manager Utilization Management Jobs in Rosedale, MD

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Manager Utilization Management information

See Rosedale, MD salary details

$37.4K

$87.3K

$160.7K

How much do manager utilization management jobs pay per year?

As of Aug 17, 2026, the average yearly pay for manager utilization management in Rosedale, MD is $87,292.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,100.00 and $105,000.00 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 popular job titles related to Manager Utilization Management jobs in Rosedale, MD?

For Manager Utilization Management jobs in Rosedale, MD, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Rosedale, MD look for?

The top searched job categories for Manager Utilization Management jobs in Rosedale, MD are:

What cities near Rosedale, MD are hiring for Manager Utilization Management jobs?

Cities near Rosedale, MD with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Rosedale, MD as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, and 4% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $87,292 per year, or $42 per hour.

Utilization Management Supervisor (Hybrid)

CareFirst

Baltimore, MD • Hybrid

Full-time

Retirement

This job post has expired today. Applications are no longer accepted.

CareFirst BlueCross BlueShield rating

7.3

Company rating: 7.3 out of 10

Based on 31 frontline employees who took The Breakroom Quiz

237th of 309 rated insurance

Job description

Resp & Qualifications

PURPOSE: 
The Supervisor, Utilization Management supervises the daily operations of the Utilization Management (UM) department to ensure the appropriate coordination of health care services and compliance with Utilization Review (UR) policies and procedures, as well as, regulatory and CareFirst's accreditation standards. We are looking for an experienced professional in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.
ESSENTIAL FUNCTIONS:

  • Supervises the daily operations of UM staff. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Ensures appropriate usage of resources in order to facilitate the UM process. Educates staff as necessary to ensure consistent performance and adherence to standards.
  • Ensures compliance within applicable state program guidelines. Evaluates compliance policies and procedures and analyzes/recommends enhancements.
  • Facilitates the collection and validation of data from UM staff to ensure consistency and accuracy. Assists in analyzing and reporting data used to support the achievement of corporate objectives, enhance operational monitoring and meet external reporting requirements.
  • Evaluates departmental processes and recommends improvement opportunities to enhance operational efficiency and support departmental objectives.
  • Provides timely communication to management regarding department operations including customer and case-related issues, operational trends, variances, reporting outcomes, action plans, etc., to support informed decision-making.

SUPERVISORY RESPONSIBILITY:
This position manages people.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Nursing OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 3 years Medical/surgical experience including, but not limited to, inpatient care, outpatient/home care and hospice care, and experience reviewing patient medical care with demonstrated leadership.
Licenses/Certifications Required Upon Hire:
RN  - Registered Nurse - State Licensure And/or Compact State Licensure
Knowledge, Skills and Abilities (KSAs)

  • Excellent analytical, problem-solving skills with ability to judge appropriateness of member services and treatments on a case by case basis.
  • Ability to multitask, prioritize and maintain a dynamic personal organization system that allows for flexibility.
  • Knowledge of accreditation standards and federal/state regulations and general principles relating to utilization review.
  • Effective written and interpersonal communication skills to engage with members, healthcare professionals, and internal colleagues.
  • Computer skills, including Microsoft Office programs.
  • Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed.  

Travel Requirements:
5% Able to travel to CareFirst sites for meetings and off site Health Services meetings

Salary Range: 82,800 - 170,775

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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