Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements. * Supports effective treatment planning, patient care ...
Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements. * Supports effective treatment planning, patient care ...
Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements. * Supports effective treatment planning, patient care ...
Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements. * Supports effective treatment planning, patient care ...
Utilization Management Director
Orange, CA · On-site
$200K - $235K/yr
The ideal candidate is a licensed clinical professional with strong utilization management experience, payer or managed care knowledge, and the ability to build a department from the ground up. Key ...
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Utilization Management Director
Orange, CA · On-site
$200K - $235K/yr
The ideal candidate is a licensed clinical professional with strong utilization management experience, payer or managed care knowledge, and the ability to build a department from the ground up. Key ...
Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements. * Supports effective treatment planning, patient care ...
Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements. * Supports effective treatment planning, patient care ...
Three (3) years of utilization review, case management, or third-party payer experience. Qualifications * Active Registered Nurse (RN) license with 3+ years of experience in utilization review or ...
Three (3) years of utilization review, case management, or third-party payer experience. Qualifications * Active Registered Nurse (RN) license with 3+ years of experience in utilization review or ...
RN - Utilization Management
Franklin, NH · On-site
Utilization Management Registered Nurse (UM RN) Job Summary We are seeking an experienced and ... Communicate with insurance providers and third-party payers to obtain authorizations and resolve ...
RN - Utilization Management
Franklin, NH · On-site
Utilization Management Registered Nurse (UM RN) Job Summary We are seeking an experienced and ... Communicate with insurance providers and third-party payers to obtain authorizations and resolve ...
Three (3) years of utilization review, case management, or third-party payer experience. Qualifications * Active Registered Nurse (RN) license with 3+ years of experience in utilization review or ...
Three (3) years of utilization review, case management, or third-party payer experience. Qualifications * Active Registered Nurse (RN) license with 3+ years of experience in utilization review or ...
Three (3) years of utilization review, case management, or third-party payer experience. Qualifications * Active Registered Nurse (RN) license with 3+ years of experience in utilization review or ...
Three (3) years of utilization review, case management, or third-party payer experience. Qualifications * Active Registered Nurse (RN) license with 3+ years of experience in utilization review or ...
... utilization management excellence. RN Utilization Lead under the general supervision of the ... payer or other review agency or organization. Knowledge of diagnostic related groups (DRGs ...
... utilization management excellence. RN Utilization Lead under the general supervision of the ... payer or other review agency or organization. Knowledge of diagnostic related groups (DRGs ...
Three (3) years of utilization review, case management, or third-party payer experience. Qualifications * Active Registered Nurse (RN) license with 3+ years of experience in utilization review or ...
Three (3) years of utilization review, case management, or third-party payer experience. Qualifications * Active Registered Nurse (RN) license with 3+ years of experience in utilization review or ...
Three (3) years of utilization review, case management, or third-party payer experience. Qualifications * Active Registered Nurse (RN) license with 3+ years of experience in utilization review or ...
Three (3) years of utilization review, case management, or third-party payer experience. Qualifications * Active Registered Nurse (RN) license with 3+ years of experience in utilization review or ...
Ensure compliance with federal, state, and payer regulations along with all relevant accreditation ... Certification in Case Management and/or Utilization Management preferred. WORK SHIFT: Days (United ...
Ensure compliance with federal, state, and payer regulations along with all relevant accreditation ... Certification in Case Management and/or Utilization Management preferred. WORK SHIFT: Days (United ...
Maintains accurate documentation of payer communications, authorization information, and level-of-care determinations in the electronic medical record in accordance with departmental standards.
Maintains accurate documentation of payer communications, authorization information, and level-of-care determinations in the electronic medical record in accordance with departmental standards.
Oversee the management of patient care utilization, ensuring appropriate healthcare services are ... Familiarity with payer requirements and regulation including Medicare, Medicaid and private ...
Oversee the management of patient care utilization, ensuring appropriate healthcare services are ... Familiarity with payer requirements and regulation including Medicare, Medicaid and private ...
Familiarity with payer requirements and regulation including Medicare, Medicaid and private insurers * Working knowledge of applications that are used to enhance utilization management based on ...
Familiarity with payer requirements and regulation including Medicare, Medicaid and private insurers * Working knowledge of applications that are used to enhance utilization management based on ...
Maintains accurate documentation of payer communications, authorization information, and level-of-care determinations in the electronic medical record in accordance with departmental standards.
Maintains accurate documentation of payer communications, authorization information, and level-of-care determinations in the electronic medical record in accordance with departmental standards.
The Director of Utilization Management holds a critical role encompassing operational oversight ... Maintains minimal denial rates by Medicare, MediCal, private and contracted payers through ...
The Director of Utilization Management holds a critical role encompassing operational oversight ... Maintains minimal denial rates by Medicare, MediCal, private and contracted payers through ...
Utilization Management RN
Canandaigua, NY · On-site
$35 - $47/hr
Utilization Management / CDS Nurse ( RN ) UM/CDS Nurse Responsibilities: * Perform extensive record ... Provide review information to payers as requested. * Perform retroactive reviews for assigned ...
Utilization Management RN
Canandaigua, NY · On-site
$35 - $47/hr
Utilization Management / CDS Nurse ( RN ) UM/CDS Nurse Responsibilities: * Perform extensive record ... Provide review information to payers as requested. * Perform retroactive reviews for assigned ...
Utilization Management RN
Canandaigua, NY · On-site
Utilization Management / CDS Nurse ( RN ) UM/CDS Nurse Responsibilities: * Perform extensive record ... Provide review information to payers as requested. * Perform retroactive reviews for assigned ...
Utilization Management RN
Canandaigua, NY · On-site
Utilization Management / CDS Nurse ( RN ) UM/CDS Nurse Responsibilities: * Perform extensive record ... Provide review information to payers as requested. * Perform retroactive reviews for assigned ...
The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers. Responsibilities and Tasks * Performs timely and accurate utilization review ...
The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers. Responsibilities and Tasks * Performs timely and accurate utilization review ...
Payer Utilization Management information
See salary details
$15.63 - $19.08
14% of jobs
$21.93 is the 25th percentile. Wages below this are outliers.
$19.08 - $22.53
14% of jobs
$22.53 - $25.98
17% of jobs
The median wage is $27.88 / hr.
$25.98 - $29.44
11% of jobs
$29.44 - $32.89
8% of jobs
$32.89 - $36.34
6% of jobs
$38.93 is the 75th percentile. Wages above this are outliers.
$36.34 - $39.79
7% of jobs
$39.79 - $43.25
7% of jobs
$43.25 - $46.70
5% of jobs
$46.70 - $50.15
5% of jobs
$50.15 - $53.61
5% of jobs
$15
$31
$53
How much do payer utilization management jobs pay per hour?
As of Jun 25, 2026, the average hourly pay for payer utilization management in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.
Full-time
Posted 5 days ago
Job description
Overview
Make an impact by supporting the right care at the right time through utilization management excellence.
Work Style: Onsite
Location: St. Agustine, FL
FTE: Full-Time (1.0 FTE)
⏰ Schedule: Monday - Friday, 3:00 PM - 11:00 PM
Plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness of healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing monitoring to support timely discharge planning. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.
Responsibilities
Key Responsibilities
Qualifications
Education & Licensure
Experience & Skills
Make an impact by supporting the right care at the right time through utilization management excellence.
Work Style: Onsite
Location: St. Agustine, FL
FTE: Full-Time (1.0 FTE)
⏰ Schedule: Monday - Friday, 3:00 PM - 11:00 PM
Plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness of healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing monitoring to support timely discharge planning. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.
Responsibilities
Key Responsibilities
- Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services.
- Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements.
- Supports effective treatment planning, patient care coordination, and appropriate resource utilization.
- Communicates authorization decisions and utilization determinations while supporting timely discharge planning efforts.
- Analyzes utilization management data and trends to identify opportunities for improved care coordination and operational efficiency.
- Collaborates with interdisciplinary teams to ensure accurate documentation, regulatory compliance, and quality patient outcomes.
Qualifications
Education & Licensure
- Registered Nurse (RN) with a current Florida nursing license required.
Experience & Skills
- Minimum of three (3) years of experience in utilization review, utilization management, or case management required.
- Knowledge of healthcare utilization guidelines, payer requirements, and regulatory compliance standards.
- Experience evaluating medical necessity, treatment plans, and appropriate levels of care.
- Strong communication and collaboration skills related to authorization determinations and care coordination.
- Demonstrated ability to analyze utilization data, identify trends, and support patient care and discharge planning initiatives.
About UF Health
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Gainesville, FL, US
Year founded
1958