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How much do pediatric utilization management jobs pay per hour?

As of Sep 14, 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 are popular job titles related to Pediatric Utilization Management jobs?

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

Pediatric Utilization Management jobs near you
Infographic showing various Pediatric Utilization Management job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 82% Physical, 2% Hybrid, and 16% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Management Specialist

Charlotte, NC • On-site

Mosaic Pediatric Therapy
Individual, Family and Community Social Assistance • 201 - 500 employees
Learn more about Mosaic Pediatric Therapyexternal

Full-time

Re-posted 18 days ago

Mosaic Pediatric Therapy rating

5.2

Company rating: 5.2 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

The Southeast's Premier ABA Therapy Provider for Children with Autism, We are a values-driven company and are dedicated to providing world-class ABA therapy services to our early childhood patients while promoting a positive and supportive culture for our team members. Top 5% nationally in employee satisfaction! Top 3% nationally in client family satisfaction!
 
 
The Utilization Management Specialist is responsible for establishing a professional and supportive contact for clients seeking to enter ABA therapy and for current clients receiving ABA services. 
Primary Responsibilites:

Conducting authorizations, benefits and clinic support for new intake and current clients.

Preferred Skills and Knowledge:

  • Excellent organization and problem-solving skills

  • Experience using electronic medical record applications (Central Reach preferred).

  • Working knowledge of HIPAA regulations

  • Excellent interpersonal skills, good oral and written communication skills

  • Good organization and time management skills

  • Must have good working knowledge of Microsoft Office or Gmail office tools (Word, Excel, PowerPoint)

  • Verify client information and benefits  

  • Email Intake packets for new clients and monitor receipt

  • Enter accurate demographic, benefit, and authorization information for clients into operating system

  • Request Financial Agreements from Client Accounts

  • Monitor availability of clinic space and providers

  • Coordinate process flow with clinics and providers

  • Maintain accurate documentation of service requests, testing, referrals and authorizations

  • Oversee receipt of authorizations and creation of accurate authorizations in operating system

  • Actively participate in Intake meetings and collaborate with providers and clinics for best Intake practices

  • Complete authorization renewals

  • Verify client eligibility weekly

  • Other duties as assigned by the intake manager

Education and Experience:

  • Bachelor's Degree preferred

  • Must be self motivated, driven, bring energy and good communication skills

  • Must convey a sense of passion about helping children with autism through ABA therapy

  • Time management and organization

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
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