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How much do pediatric utilization management jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for pediatric utilization management in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is pediatric utilization management?

Pediatric Utilization Management (UM) is a healthcare process that reviews and evaluates the medical necessity, efficiency, and appropriateness of healthcare services provided to children. Professionals in this field assess treatment plans, hospital stays, procedures, and medications to ensure they align with evidence-based guidelines and are truly needed for a pediatric patient's care. The goal is to optimize health outcomes for children while managing healthcare costs and resources efficiently. Pediatric UM often involves collaboration between healthcare providers, insurance companies, and families to make informed decisions about a child's medical care.

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

Professionals in Pediatric Utilization Management often encounter challenges such as balancing cost-effective care with the unique needs of pediatric patients, staying updated with evolving clinical guidelines, and communicating effectively with both providers and families. Navigating insurance requirements while advocating for appropriate treatments requires strong clinical knowledge and negotiation skills. Building collaborative relationships with multidisciplinary teams and ongoing professional development can help address these challenges and ensure the best outcomes for young patients.

What are the key skills and qualifications needed to thrive as a pediatric utilization management nurse, and why are they important?

To thrive in Pediatric Utilization Management, you need a solid background in pediatric nursing, critical thinking, and knowledge of healthcare regulations, generally supported by an RN license and experience in pediatrics. Familiarity with utilization review software, electronic medical records (EMRs), and certification such as Certified Case Manager (CCM) or Utilization Review Accreditation Commission (URAC) is often required. Excellent communication, attention to detail, and strong organizational skills are crucial for collaborating with medical teams and advocating for appropriate patient care. These competencies ensure effective care coordination, regulatory compliance, and optimal outcomes for pediatric patients.

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

AspectPediatric Utilization ManagementPediatric Case Management
CredentialsRN, licensed healthcare professionals, certifications in utilization reviewRN, social worker, case management certification
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, clinics, community health settings
Employer & Industry UsageInsurance providers, managed care organizationsHospitals, outpatient clinics, social services
FocusReviewing medical necessity, approving services, optimizing resource useCoordinating care, supporting patient needs, discharge planning

While both roles involve working with pediatric patients, Pediatric Utilization Management primarily focuses on reviewing and approving healthcare services for medical necessity within insurance or managed care settings. Pediatric Case Management emphasizes coordinating ongoing patient care and support services across healthcare providers and community resources.

More about Pediatric Utilization Management jobs

What cities are hiring for Pediatric Utilization Management jobs?

Cities with the most Pediatric Utilization Management job openings:

What states have the most Pediatric Utilization Management jobs?

States with the most job openings for Pediatric Utilization Management jobs include:

What job categories do people searching Pediatric Utilization Management jobs look for?

The top searched job categories for Pediatric Utilization Management jobs are:

Pediatric Utilization Management jobs near you
Infographic showing various Pediatric Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Management Registered Nurse

Valley Children's Healthcare

Madera, CA • On-site

$57.29 - $81.72/day

Other

Re-posted 23 days ago

Valley Children's Hospital rating

6.4

Company rating: 6.4 out of 10

Based on 14 frontline employees who took The Breakroom Quiz

755th of 1,061 rated hospitals

Job description

Job Summary:
The Utilization Management Nurse supports the case management department by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria, active involvement in denial management, acting as a resource to staff regarding clinical criteria, communication with payors to address concerns and other duties as assigned. The Utilization Management Nurse will work collaboratively with the Utilization Nurse Program Coordinator to ensure compliance with regulatory, organizational and department requirements. The Utilization Review Nurse will receive direction from the Utilization Review Program Coordinator for daily and long term tasks and projects.
Qualifications:
Education
  • Associates Degree Nursing (required)
  • Bachelors Degree Nursing or related field (preferred)
Licenses and Certifications
  • RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing (required)
Work Experience
  • Minimum three (3) years Full time equivalent RN experience in an acute care hospital. (required)
  • Pediatric experience and experience in Case Management and/or Utilization Review. (preferred)
Skills and Abilities
  • Knowledge of UM regulations.
    Knowledge of private and public payer reimbursement practices and procedures.
    Excellent organizational and communication skills and ability to work with a variety of health care professionals.
    Ability to work independently.
  • Computer Skills Proficiency with word processing, spreadsheets and database software.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Compensation Range:
$57.29 - $81.72
Workshift:
Day (United States of America)
Position Exempt:
No
FTE %:
90
Scheduled Weekly Hours:
36
Daily Hours:
8
Have Questions?
Call Recruitment Services at 559-353-7071 or email us at recruiting@valleychildrens.org
Disclaimer: Final compensation will be dependent upon skills and experience.

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