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Um Specialist Jobs (NOW HIRING)

Gonzaba Medical Group

UM Nurse

San Antonio, TX · On-site

Provides clinical perspective/input to Review team, UM team and Referral Specialists. * Summarizes medical records documentation for physician medical necessity review. * Composes Denial letters ...

Gonzaba Medical Group

UM Nurse

San Antonio, TX · On-site

Provides clinical perspective/input to Review team, UM team and Referral Specialists. * Summarizes medical records documentation for physician medical necessity review. * Composes Denial letters ...

Gonzaba Medical Group

UM Nurse

San Antonio, TX · On-site

Provides clinical perspective/input to Review team, UM team and Referral Specialists. * Summarizes medical records documentation for physician medical necessity review. * Composes Denial letters ...

Gonzaba Medical Group

UM Nurse

San Antonio, TX · On-site

Provides clinical perspective/input to Review team, UM team and Referral Specialists. * Summarizes medical records documentation for physician medical necessity review. * Composes Denial letters ...

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Um Specialist information

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$27K

$57.4K

$97.5K

How much do um specialist jobs pay per year?

As of Aug 7, 2026, the average yearly pay for um specialist in the United States is $57,372.00, according to ZipRecruiter salary data. Most workers in this role earn between $38,500.00 and $74,000.00 per year, depending on experience, location, and employer.

What is a UM specialist?

UM Specialists, or Utilization Management Specialists, are healthcare professionals who review medical cases to ensure that patients receive appropriate and necessary care. They evaluate treatment plans, coordinate with healthcare providers, and help manage costs by making sure that medical services meet established guidelines and policies. UM Specialists typically work for insurance companies, hospitals, or managed care organizations, and play a key role in balancing quality patient care with cost efficiency.

What are some common challenges faced by Utilization Management (UM) specialists in balancing patient care and cost efficiency?

UM Specialists often navigate the challenge of ensuring patients receive appropriate and timely care while also adhering to insurance and regulatory guidelines to control costs. This can involve complex decision-making, especially when medical necessity is unclear or when providers and patients have differing expectations. Effective communication with healthcare providers and staying current with clinical guidelines are essential for resolving these situations. Additionally, UM Specialists must manage high caseloads and tight deadlines, making strong organizational and negotiation skills crucial for success in the role.

What are the key skills and qualifications needed to thrive as a UM specialist, and why are they important?

To thrive as a Utilization Management (UM) Specialist, you need a background in healthcare (often nursing or allied health), knowledge of medical terminology, and an understanding of insurance guidelines. Familiarity with UM software, electronic health records (EHRs), and insurance pre-authorization systems is typically required. Strong analytical thinking, attention to detail, and effective communication skills help UM Specialists review cases and coordinate with providers. These skills ensure appropriate use of healthcare resources, compliance with regulations, and effective patient care management.

What is the difference between Um Specialist vs Audiologist?

AspectUm SpecialistAudiologist
Required CredentialsTypically a certification or associate degree in hearing healthDoctoral degree (Au.D.) in audiology, state licensure
Work EnvironmentHearing aid clinics, ENT offices, retail storesHospitals, clinics, private practices, educational settings
Industry UsageCommonly employed in hearing aid sales and fittingFocus on diagnosis, treatment, and rehabilitation of hearing loss

While both Um Specialists and Audiologists work in hearing health, Um Specialists primarily focus on fitting and selling hearing aids, often with certification or associate degrees. Audiologists have advanced degrees and are trained to diagnose and treat a broader range of hearing and balance disorders. The roles overlap in hearing aid fitting, but Audiologists provide comprehensive audiological care.

More about Um Specialist jobs
What job categories do people searching Um Specialist jobs look for? The top searched job categories for Um Specialist jobs are:
Um Specialist jobs near you
Infographic showing various Um Specialist job openings in the United States as of August 2026, with employment types broken down into 84% Full Time, 13% Part Time, and 3% Contract. Highlights an 79% Physical, 2% Hybrid, and 19% Remote job distribution, with an average salary of $57,372 per year, or $27.6 per hour.

Behavioral Health Utilization Management Specialist

Barry County Community Mental Health Aut

Hastings, MI • On-site

$58K/yr

Full-time

Re-posted 29 days ago

Job description

Location: Primarily Remote (Michigan-based)
Schedule: Full-Time | Option for Four-Day Work Week

Position Overview:
We are seeking a detail-oriented and clinically skilled Behavioral Health Utilization Management (UM) Specialist to join our team. This role is responsible for reviewing behavioral health services to ensure medical necessity, regulatory compliance, and appropriate level of care determinations. The ideal candidate brings strong clinical judgment, experience with managed care or utilization management processes, familiarity with Community Mental Health/CMHSP operations, and the ability to work independently in a remote environment.

Key Responsibilities:

  • Conduct utilization reviews for behavioral health services, including initial, concurrent, and retrospective reviews
  • Assess clinical documentation to determine medical necessity and appropriate level of care
  • Ensure compliance with state, federal, and payer-specific regulations and guidelines
  • Collaborate with providers, care teams, and internal stakeholders to support quality service delivery
  • Maintain accurate and timely documentation of all UM activities
  • Participate in audits, quality improvement initiatives, and process enhancements
  • Stay current on best practices, regulatory updates, and industry standards in behavioral health and managed care

Qualifications:

  • Master’s degree in Social Work, Professional Counseling, Psychology, or a related behavioral health field
  • Current, active licensure in the State of Michigan (e.g., LMSW/LLMSW, LPC/LLPC, LLP/TLLP)
  • Prior experience in utilization management, managed care, or similar review functions required
  • Strong attention to detail and critical thinking skills
  • Excellent written and verbal communication abilities
  • Ability to work independently while managing multiple priorities

Preferred Qualifications:

  • Experience with behavioral health payer guidelines and authorization processes
  • Familiarity with electronic health records and UM software systems

What We Offer:

  • Four-day work week promoting work-life balance
  • Primarily remote work environment with flexible scheduling
  • Collaborative and mission-driven team culture
  • Opportunities for professional growth and development

How to Apply:
Interested candidates should submit a resume and cover letter outlining their relevant experience and licensure status.

We are an equal opportunity employer committed to diversity, equity, and inclusion in the workplace.