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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

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

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 ...

TEXASCONNECT INC

UM Nurse Specialist, LVN (HYBRID)

Dallas, TX · On-site

$27.25 - $36.50/hr

The UM Nurse Specialist provides organizational support in the Utilization Management Department; efficiently processes Pre-Service Authorization requests within regulated turn-around times. Works ...

Altais, Inc.

UM Medical Director - Casual

... Family Care Specialists. Together, we're building a stronger, more connected healthcare system ... UM Committee Health Plan Joint Operations Meetings Hospital Joint Operations Meeting One Altais ...

Altais

UM Medical Director - Casual

California, MO · On-site

$223 - $267/hr

... Specialists. Together, we're building a stronger, more connected healthcare system. **About the ... UM CommitteeHealth Plan Joint Operations MeetingsHospital Joint Operations MeetingOne Altais ...

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Um Specialist information

See salary details

$27K

$57.4K

$97.5K

How much do um specialist jobs pay per year?

As of Aug 25, 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 87% Full Time, 11% Part Time, and 2% Contract. Highlights an 78% Physical, 2% Hybrid, and 20% Remote job distribution, with an average salary of $57,372 per year, or $27.6 per hour.

UM Specialist

Cincinnati, OH

New Vista Behavioral Health
Offices of Mental Health Practitioners • 51 - 200 employees
Learn more about New Vista Behavioral Healthexternal

$24 - $32/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

Job description

UM Specialist
Pay: $24 - $32hr
Location: 10123 Alliance Road, Cincinnati, Ohio 45242
Schedule: Full Time
Who we are
At NewVista, the mission is to inspire hope and deliver holistic care to those in need of behavioral health services and addiction services in a safe and healing environment. We operate Behavioral Health Hospitals, Detox and Residential facilities, and a variety of other vertical line business that are here to support those who are seeking recovery.
The Role Itself
The Utilization Management Appeals Specialist is responsible for the appeals of denied claims for Inpatient and Outpatient Services. This includes writing clinical justification for admission and continued stay criteria based on clinical documentation in the patient record. The UM Appeals Specialist will accurately report the appeals status to the Corporate Director of UM. The UM Appeals Specialist will follow department and department procedures and ensure effective communication with all relevant departments regarding patient care needs.
  • Oversees the appeals process for all denied claims on assigned caseload.
  • Reviews the medical record to identify clinical criteria for an appeal completion and submission.
  • Maintains an active involvement and awareness of all denials on their caseload to include appeals status
  • Oversees the coordination with managed care companies or other third-party payors regarding peer reviews, retrospective reviews and appeals.
  • Maintains logs of all denials along with updated status of same.
  • Other Duties as assigned
Job Requirements:
  • Bachelors Degree in Nursing, Social Work, or related field preferred
  • Must be 21 or older
  • 2 yrs exp in healthcare setting writing clinical or medical necessity appeals.
  • LPN, RN, LSW, LPC are applicable licenses for this role.
Why You’ll Love It Here (Full‑Time Benefits)
• Multiple medical plan options, Vista Wellness (physician/pharmacy), Dental, Vision
• Generous PTO and paid holidays
• 401(k) with company contribution; Life and disability coverage
• Tuition reimbursement up to $15,000 and student loan forgiveness programs

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