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Medicare Utilization Management Program Manager Jobs

UHS

Director Utilization Management

Plymouth, IN · On-site

Responsibilities Director Utilization Management Michiana Behavioral Health is dedicated to creating a therapeutic environment that helps patients restore their health and get a fresh start. Located ...

Devoted Health

Utilization Management Coordinator

$21.70 - $27/hr

Prior experience in Medicare Advantage or managed care * Intake, authorization, or clinical ... Parental leave program * 401K program * And more.... *Our total rewards package is for full time ...

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Medicare Utilization Management Program Manager information

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How much do medicare utilization management program manager jobs pay per year?

As of Sep 11, 2026, the average yearly pay for medicare utilization management program manager 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 is a Medicare Utilization Management Program Manager?

A Medicare Utilization Management Program Manager is a healthcare professional responsible for overseeing and optimizing the use of medical services for Medicare beneficiaries. They ensure that patients receive appropriate, necessary, and cost-effective care by developing and managing utilization review processes, complying with federal regulations, and coordinating with healthcare providers. Their role includes analyzing healthcare data, implementing policies to prevent unnecessary services, and maintaining quality standards within the Medicare program. They often work for insurance companies, healthcare organizations, or government agencies.

How does a Medicare Utilization Management Program Manager collaborate with clinical and administrative teams to ensure effective care delivery?

As a Medicare Utilization Management Program Manager, you will regularly coordinate with clinical staff, such as nurses and physicians, to review patient cases and ensure that care provided aligns with Medicare guidelines. You’ll also work closely with administrative teams to implement process improvements, monitor compliance, and analyze utilization data. Effective communication and cross-functional collaboration are key, as you’ll often facilitate meetings, provide training, and resolve issues that arise between departments. This collaborative environment helps ensure that members receive appropriate, cost-effective care while maintaining regulatory compliance.

What are the key skills and qualifications needed to thrive as a Medicare Utilization Management Program Manager, and why are they important?

To thrive as a Medicare Utilization Management Program Manager, you need expertise in healthcare management, regulatory compliance, and utilization review, typically supported by a clinical background (such as RN or LPN) and a bachelor's or master's degree in a health-related field. Familiarity with Medicare guidelines, claims processing systems, and utilization management software is essential, and certification such as CCM (Certified Case Manager) can be advantageous. Strong leadership, analytical thinking, and effective communication skills help coordinate teams, interpret policies, and ensure quality outcomes. These skills and qualifications are crucial for maintaining compliance, optimizing resource use, and ensuring members receive appropriate, cost-effective care.

What are popular job titles related to Medicare Utilization Management Program Manager jobs?

For Medicare Utilization Management Program Manager jobs, the most frequently searched job titles are:

Infographic showing various Medicare Utilization Management Program Manager job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, and 4% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $91,011 per year, or $43.8 per hour.

Utilization Management Coordinator

Ludington, MI

West Michigan Community Mental Health System
Offices of Mental Health Practitioners • 51 - 200 employees
Learn more about West Michigan Community Mental Health Systemexternal

Full-time

Re-posted 23 hours ago

Job description

The Utilization Management Coordinator is responsible for performing retrospective monitoring and audit functions relative to WMCMH utilization management processes/systems. The Utilization Management Coordinator will monitor and audit the effectiveness of the WMCMH Utilization Management processes/systems, provide data to support organizational utilization decision-making, facilitate the WMCMH Utilization Management Committee and be an active participant in the Lakeshore Regional Entity UM ROAT and other regional and state UM workgroups/committees as appropriate. The Utilization Management Coordinator will be housed on the Operations Team and will work very closely with other members of the organization.

JOB DUTIES: Utilization Management - Through retrospective review and use of both strong QI principles and strong data aggregation and analysis skills, the Utilization Management Coordinator will: Perform monitoring and audit functions (objective examination) relative to utilization management and/or effectiveness of WM utilization management (i.e., size and composition and accessibility of WM network; appropriateness of authorization bundles; compliance with WM authorization decision guidelines; ensure presence of golden thread; ensure consistent and compliant authorization decisions and supporting documentation, etc.). In response to monitoring and audit functions, facilitate the development and monitoring of performance improvement plans as appropriate. Provide/Aggregate data to support the need for new programs and/or discontinuing programs that are ineffective or inefficient

Provide/Aggregate data to support the need for incorporating new or discontinuing the use of evidence-based practices. Provide/Aggregate data to support maintenance/updates to authorization decision guidelines. Facilitate the WMCMH Utilization Management Committee Participate in the Lakeshore Regional Entity UM ROAT and other state/regional UM workgroups as appropriate.

Back-Up Coverage - Provide limited, short-term/backup coverage for other Operations or organizational Coordinators as needed.

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