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Outpatient Utilization Management Jobs (NOW HIRING)

UHS

Director Utilization Management

Plymouth, IN · On-site

Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ... utilization management for both mental health and substance abuse behavioral health disorders.

Liberty Health

UTILIZATION MANAGEMENT RN

Wilmington, NC · On-site

Monitor members both inpatient/outpatient - provide updates to Director of Utilization Management and the clinical care teams * Recommend more appropriate care if required * Assess and coordinate ...

UHS

Utilization Management Coordinator

Chicago, IL · On-site

$58K - $75K/yr

... outpatient services. The Utilization Management Coordinato r performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer ...

UHS

Utilization Management Coordinator

Chicago, IL

... outpatient services. The Utilization Management Coordinato r performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer ...

UHS

Utilization Management Coordinator

Chicago, IL

... outpatient services. The Utilization Management Coordinato r performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer ...

UHS

Utilization Management Coordinator

Chicago, IL · On-site

... outpatient services. The Utilization Management Coordinato r performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer ...

UHS

Utilization Management Coordinator

Chicago, IL

... outpatient services. The Utilization Management Coordinato r performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer ...

UHS

Director Utilization Management

Plymouth, IN · On-site

Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ... utilization management for both mental health and substance abuse behavioral health disorders.

UHS

Director Utilization Management

Plymouth, IN · On-site

Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ... utilization management for both mental health and substance abuse behavioral health disorders.

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Outpatient Utilization Management information

See salary details

$39K

$89.5K

$163K

How much do outpatient utilization management jobs pay per year?

As of Sep 10, 2026, the average yearly pay for outpatient utilization management in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What is outpatient utilization management?

Outpatient utilization management is a healthcare process focused on ensuring that patients receive appropriate, efficient, and cost-effective care in outpatient settings. Professionals in this field review medical services, coordinate care, and assess treatment plans to confirm they meet established guidelines and medical necessity. Their goal is to optimize patient outcomes while managing healthcare resources responsibly. This often involves collaboration with healthcare providers, insurance companies, and patients to facilitate the best possible care outside of hospital admissions.

What are the key skills and qualifications needed to thrive in outpatient utilization management?

To thrive in Outpatient Utilization Management, you need a background in nursing or healthcare, strong knowledge of medical necessity criteria, and familiarity with insurance guidelines, typically supported by RN licensure or a related healthcare degree. Experience with utilization management software, electronic health records (EHRs), and familiarity with CMS or Milliman guidelines is often required. Strong analytical, communication, and collaboration skills help professionals effectively advocate for patients while coordinating across clinical and administrative teams. These skills are crucial to ensure appropriate care authorization, optimize resource use, and support quality patient outcomes in outpatient settings.

What are some common challenges faced in outpatient utilization management, and how can they be addressed?

Professionals in Outpatient Utilization Management often face challenges such as balancing cost-effectiveness with quality patient care and navigating complex insurance policies. Managing high caseloads and ensuring timely authorization for services can also be demanding. Addressing these challenges requires strong communication skills, up-to-date knowledge of payer guidelines, and effective collaboration with providers and interdisciplinary teams. Many organizations offer ongoing training and support to help team members stay current and manage workflow efficiently.

What is the difference between Outpatient Utilization Management vs Outpatient Case Management?

AspectOutpatient Utilization ManagementOutpatient Case Management
Primary FocusReviewing medical necessity and authorizations for outpatient servicesCoordinating ongoing patient care and discharge planning
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, clinics, outpatient facilities, community health programs
CredentialsTypically requires healthcare background, certifications like URAC or CCMOften requires nursing, social work, or case management certifications

While both roles involve outpatient healthcare, Outpatient Utilization Management primarily focuses on reviewing and authorizing services to ensure medical necessity, whereas Outpatient Case Management emphasizes coordinating patient care and discharge planning. Understanding these differences helps clarify career paths and employer expectations in outpatient healthcare settings.

Is outpatient utilization management a growing field?

Outpatient utilization management is a growing field due to increasing demand for cost-effective healthcare and emphasis on outpatient services. Professionals in this area often use data analysis and care coordination skills, with certifications like URAC or AAPC enhancing job prospects.

What are popular job titles related to Outpatient Utilization Management jobs?

For Outpatient Utilization Management jobs, the most frequently searched job titles are:

UTILIZATION MANAGEMENT RN

Wilmington, NC • On-site

Liberty Healthcare
Health Care and Social Assistance • 5 - 10K employees
Learn more about Liberty Healthcareexternal

Other

Posted 6 days ago

Job description

Utilization Management RN

There's no place like Liberty Health

Come explore career opportunities with Liberty Health, a dynamic leader in the healthcare industry. Join us!

We are currently seeking an experienced:

UTILIZATION MANAGEMENT RN

JOB SUMMARY:

Day-to-day management of Utilization Management queues, dashboards, members, ensuring all Utilization Management activities, which include authorization timeliness, discharge planning, adherence to policies and procedures to ensure high quality and cost-effective utilization management services.

Ability to work decision letters timely and accurately

Quality monitoring focusing on medical necessity guidelines and discharge planning opportunities to lower levels of care

Assist the Director of Utilization Management with the Utilization Management Reports to be reviewed by Executive Leadership.

Ability to contribute to the UM team to ensure compliant execution of UM program

Review admissions and service requests for the following:

  • Authorization requests to ensure appropriate care for members and within clinical guidelines
  • Monitor members both inpatient/outpatient – provide updates to Director of Utilization Management and the clinical care teams
  • Recommend more appropriate care if required

Assess and coordinate discharge planning with Care Team.

Assist co-workers with issues related to coding, medical records/documentation, pre-certification reimbursement and claim denials/appeals.

Use critical thinking and problem-solving to navigate through the complexities of a member's health conditions while maintaining coverage within the program guidelines.

Ability to focus on interventions for improvement

Provides appropriate responses to providers regarding UM questions or direct these questions to the Director of Utilization Management

Monitors utilization management queues and dashboards, assuring compliance with reporting and turnaround times.

Participates in the interdisciplinary approach to support continuity of care

Participates in the Case Management processes and assists with the development of case management programs

Ability to participate and contribute with the written policies and procedures and workflows

Ability to participate in the On-Call rotation to ensure timeliness is maintained

Ability to work occasional after hours to ensure timeliness is maintained.

Contribute to and attend UM meetings and UM huddles.

Other duties as assigned

Less than 10% travel to the corporate office for Department meetings

JOB REQUIREMENTS:

  • Licensed Registered Nurse credentialed from an accredited school/college with 3–5 years of clinical experience
  • Maintain Active Registered Nurse License, (Compact, RN preferred)
  • 1–5 years managed care Utilization Management experience (preferably with a Health Plan)
  • Demonstrated experience in health plan utilization management, initial reviews, facility concurrent review discharge planning, and case management required.
  • Medicare Advantage experience required
  • Experience with InterQual or MCG authorization criteria preferred.
  • Excellent computer skills and the ability to learn new systems are required.
  • Strong attention to detail, organizational skills, and interpersonal skills are required.
  • Demonstrated ability to problem-solve and manage professional relationships.
  • Healthcare industry knowledge
  • Excellent listening, verbal, written and interpersonal communication skills.
  • High level of professionalism and confidentiality, with a strong customer focus.
  • Can adapt well to operational needs with excellent follow-up skills.
  • Must be self-motivated, with a work ethic of dedication and the discipline to work independently.
  • Must have a valid driver's license.
  • Proven ability to communicate concisely and confidently with all staff levels. Clearly communicates instructions to remote users.

Visit www.libertycareers.com for more information. Background checks/drug-free workplace. EOE.

Apply