Position Summary and Purpose The Manager of Utilization Management (UM) leads the strategic and operational oversight of utilization review and management across the academic healthcare system. This ...
Position Summary and Purpose The Manager of Utilization Management (UM) leads the strategic and operational oversight of utilization review and management across the academic healthcare system. This ...
Position Summary and Purpose The Manager of Utilization Management (UM) leads the strategic and operational oversight of utilization review and management across the academic healthcare system. This ...
Position Summary and Purpose The Manager of Utilization Management (UM) leads the strategic and operational oversight of utilization review and management across the academic healthcare system. This ...
Utilization Management/Utilization Review Tasks An employee in this class, under general direction, performs Utilization Management/Utilization Review tasks to ensure delivery of medically necessary ...
Utilization Management/Utilization Review Tasks An employee in this class, under general direction, performs Utilization Management/Utilization Review tasks to ensure delivery of medically necessary ...
Utilization Management Nurse We are seeking a dedicated Utilization Management Nurse to provide timely and appropriate prior approval services to members and healthcare providers. The role involves ...
Utilization Management Nurse We are seeking a dedicated Utilization Management Nurse to provide timely and appropriate prior approval services to members and healthcare providers. The role involves ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Coordinates with healthcare providers to ensure compliance with utilization management guidelines. * Supports the optimization of treatment plans to promote effective patient care and appropriate ...
Coordinates with healthcare providers to ensure compliance with utilization management guidelines. * Supports the optimization of treatment plans to promote effective patient care and appropriate ...
Coordinates with healthcare providers to ensure compliance with utilization management guidelines. * Supports the optimization of treatment plans to promote effective patient care and appropriate ...
Coordinates with healthcare providers to ensure compliance with utilization management guidelines. * Supports the optimization of treatment plans to promote effective patient care and appropriate ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
RN Case Manager - Utilization Management
Newburgh, NY · On-site
$112 - $127/hr
N/AThe RN Case Manager Utilization Management is responsible for supporting the physician and interdisciplinary team in facilitating patient care, at the appropriate level of care, with the ...
RN Case Manager - Utilization Management
Newburgh, NY · On-site
$112 - $127/hr
N/AThe RN Case Manager Utilization Management is responsible for supporting the physician and interdisciplinary team in facilitating patient care, at the appropriate level of care, with the ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Coordinates with healthcare providers to ensure compliance with utilization management guidelines. * Supports the optimization of treatment plans to promote effective patient care and appropriate ...
Coordinates with healthcare providers to ensure compliance with utilization management guidelines. * Supports the optimization of treatment plans to promote effective patient care and appropriate ...
Case Manager - Utilization Management
Anaheim, CA · On-site
$30.28 - $43.32/hr
Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care ...
Case Manager - Utilization Management
Anaheim, CA · On-site
$30.28 - $43.32/hr
Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care ...
Coordinates with healthcare providers to ensure compliance with utilization management guidelines. * Supports the optimization of treatment plans to promote effective patient care and appropriate ...
Coordinates with healthcare providers to ensure compliance with utilization management guidelines. * Supports the optimization of treatment plans to promote effective patient care and appropriate ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Summary Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points ...
Utilization Management Nurse
Columbus, IN · On-site
Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization Management ...
Quick apply
Utilization Management Nurse
Columbus, IN · On-site
Manager of Utilization Management Employment Type: Full-Time, Exempt Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization Management ...
Nurse Case Manager, Utilization Management
Manhattan, NY · On-site
$89K - $106K/yr
... Utilization Management • Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures, • Identify and participate in quality improvement ...
Nurse Case Manager, Utilization Management
Manhattan, NY · On-site
$89K - $106K/yr
... Utilization Management • Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures, • Identify and participate in quality improvement ...
Case Manager - Utilization Management
Anaheim, CA · On-site
$30.28 - $43.32/hr
Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works ...
Case Manager - Utilization Management
Anaheim, CA · On-site
$30.28 - $43.32/hr
Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works ...
Care Manager - Utilization Management (Inpatient)
New York, NY · On-site
$2.4K/wk
Gross Pay (weekly): $2480.0 Taxable Pay (weekly): 2480.0 Non-taxable Pay (weekly): 0.0 RN - CARE MANAGER Location: Bronx, NY Scheduled Hours : 40
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Care Manager - Utilization Management (Inpatient)
New York, NY · On-site
$2.4K/wk
Gross Pay (weekly): $2480.0 Taxable Pay (weekly): 2480.0 Non-taxable Pay (weekly): 0.0 RN - CARE MANAGER Location: Bronx, NY Scheduled Hours : 40
Meet timelines and quality standards related to Utilization Management. Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures. Identify and ...
Meet timelines and quality standards related to Utilization Management. Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures. Identify and ...
Manager Utilization Management information
See salary details
$39K - $50.7K
9% of jobs
$59.3K is the 25th percentile. Wages below this are outliers.
$50.7K - $62.4K
22% of jobs
$62.4K - $74K
11% of jobs
The median wage is $81.2K / yr.
$74K - $85.7K
14% of jobs
$85.7K - $97.4K
12% of jobs
$104.7K is the 75th percentile. Wages above this are outliers.
$97.4K - $109.1K
13% of jobs
$109.1K - $120.8K
13% of jobs
$120.8K - $132.5K
5% of jobs
$132.5K - $144.1K
2% of jobs
$144.1K - $155.8K
0% of jobs
$155.8K - $167.5K
0% of jobs
$39K
$91K
$167.5K
How much do manager utilization management jobs pay per year?
As of Aug 22, 2026, the average yearly pay for manager utilization management in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 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?
| Aspect | Manager Utilization Management | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, often with management or utilization review certifications | RN, with certifications in utilization review or case management |
| Work Environment | Supervises teams, manages policies, oversees utilization review processes | Performs patient chart reviews, assesses medical necessity, collaborates with providers |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare organizations |
| Search & Comparison Intent | Yes | Yes |
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.
More about Manager Utilization Management jobs
What cities are hiring for Manager Utilization Management jobs?
Cities with the most Manager Utilization Management job openings:
What are the most commonly searched types of Utilization Management jobs?
The most popular types of Utilization Management jobs are:
What states have the most Manager Utilization Management jobs?
States with the most job openings for Manager Utilization Management jobs include:
What job categories do people searching Manager Utilization Management jobs look for?
The top searched job categories for Manager Utilization Management jobs are:
Full-time
Posted 15 days ago
Job description
Primary Location: Peace - LouisvilleAddress: 2020 Newburg Rd.
Louisville, KY 40205
Shift: First Shift (United States of America)Job Description Summary: About UofL Health:
UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehabilitation Institute and Brown Cancer Center.
With more than 12,000 team members-physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals-UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.Job Description:
UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehabilitation Institute and Brown Cancer Center.
With more than 12,000 team members-physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals-UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.Job Description:
Position Summary and Purpose
The Manager of Utilization Management (UM) leads the strategic and operational oversight of utilization review and management across the academic healthcare system. This role ensures appropriate resource utilization, regulatory compliance, and alignment with clinical and financial goals. The Manager collaborates with medical staff, case management, revenue cycle, and IT to optimize care delivery and reimbursement.
Essential Functions:
1. Manage the day-to-day operations of the utilization review staff, including training, performance evaluation, and setting performance standards.
2. Create, implement, and maintain policies and procedures for the UM program, ensuring they align with regulations and organizational goals
3. Analyze UM metrics, identify trends, and prepare reports for senior management or quality improvement committees to guide decision-making and demonstrate the impact of the program.
4. Monitor the clinical review process to ensure patient care is appropriate, effective, and timely, and collaborate with physicians, case management and other professionals to improve utilization.
5. Identify opportunities to enhance the efficiency and accuracy of UM processes, often by working with physician advisors, case management, nursing leadership, and revenue cycle.
6. Ensure the department complies with all applicable state and federal guidelines and manage audits from regulatory agencies or health plans.
7. Provide mentorship, training and performance evaluations.
8. Ensure accurate documentation and data capture for billing and compliance.
9. Facilitate secondary reviews and appeals processes.
10. Performs other duties as assigned.
Other Functions:
Participate in UM system-wide UM committees and initiatives.
Analyze utilization trends and recommend process improvements.
Coordinate certified training programs (e.g., InterQual, MCG).
Partner with IT to optimize UM-related systems (e.g., EMR, InterQual).
Job Requirements
(Education, Experience, Licensure and Certification)
Education: Bachelor's degree in nursing or related field, master's degree preferred.
License: Active RN license or LCSW required to practice in the state of Kentucky.
Certification: Case/Utilization Management (e.g., ACM, CCM, CMAC).
Experience: Minimum seven years of UM/Case Management experience in an acute care of academic health system. Minimum 4 years leadership experience.
Job Competency:
Knowledge, Skills, and Abilities critical to this role:
Strategic thinking
Deep understanding of clinical workflows and regulatory requirements.
Strong communication and stakeholder engagement skills.
Data-driven decision-making and continuous improvement mindset.
UofL Health Core Expectation:
At UofL Health, we expect all our employees to live the values of honesty, integrity and compassion and demonstrate these values in their interactions with others and as they deliver excellent patient care by:
Honoring and caring for the dignity of all persons
Ensuring the highest quality of care for those we serve
Working together as a team to achieve our goals
Improving continuously by listening, and asking for and responding to feedback
Seeking new and better ways to meet the needs of those we serve
Using our resources wisely
Understanding how each of our roles contributes to the success of UofL Health