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How much do pediatric utilization management jobs pay per hour?

As of Jun 8, 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 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.

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 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.
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 May 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Nurse Registered Utilization Management- Part Time

Nurse Registered Utilization Management- Part Time

St. Joseph's Health

Paterson, NJ • On-site

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

St. Joseph's Health (New Jersey) rating

7.3

Company rating: 7.3 out of 10

Based on 44 frontline employees who took The Breakroom Quiz

293rd of 869 rated healthcare providers

Job description

Job Description
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and organizational role. The UM RN ensures optimal patient care delivery while supporting compliance, quality outcomes, and effective resource utilization. The role is responsible for the assessment of medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate but ensures that an authorization is obtained from the payer, if required, and that the documentation supports the care delivered in such a way that minimizes risks of denials.
Qualifications
Work requires the knowledge of theories, principles, and concepts normally acquired through completion of a Bachelor of Science in Nursing and least at least 3 years of previous nursing experience. Preferred 3+ years of Utilization Review or Case Management experience. Case Management Society of America Certification CCM preferred. Licensure required as a Registered Nurse by the State of New Jersey.
About Us
St. Joseph's Health is recognized for the expertise and compassion of its highly skilled and responsive staff. The combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care".
Benefits Eligibility: (Full-time and Part-time Employees-over 20 hours a week)
  • Competitive salary*
  • Robust benefits with health, dental, Rx and vision plans
  • 403b retirement plan options with company match**
  • Health & Wellness*
  • Non-Profit Health System - eligible for Federal Student Loan Forgiveness
  • PTO, and paid holidays
  • Tuition reimbursement
  • Employee Assistance Program
  • LTD : Long Term Disability
  • Life Insurance Options
  • Onsite Day care Program

*Available for Per Diem Employees and Part-time Employees working under 20 hours per week.
**403b Company Match not applicable for Per Diem Employees and Part-time Employees working under 20 hours per week.
Pay transparency: St. Joseph's Health provides a salary range to comply with New Jersey Law. The rate of pay for each position will be determined based on a variety of factors including the candidate's relevant experience, qualifications, skills, etc." The salary range does not include incentives, differential pay or other forms of compensation.
About the Team
St. Joseph's University Medical Center is an academic tertiary care medical center and state designated trauma center, located on the Paterson campus, regularly accepts referrals of difficult or unusual cases from other hospitals and physicians and performs both complex and routine procedures.
The Medical Center offers a full complement of specialty and subspecialty services including ambulatory, behavioral health, cardiovascular, emergency/trauma, internal medicine, neuroscience, oncology, orthopedic/spine, rehabilitation, surgical specialty, women's health, imaging and pediatrics.
The nursing team at St. Joseph's University Medical Center, which includes St. Joseph's Children's Hospital, has held the Magnet Award for Nursing Excellence, the profession's highest honor, since 1999. They are also recipients of the prestigious 2010 Magnet Prize™ - one of only 8 Magnet-designated hospitals to ever receive The Magnet Prize, and the only one worldwide to receive the 2010 award.

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