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Um Specialist Jobs (NOW HIRING)

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 ...

Altais, Inc.

UM Medical Director - Casual

... Family Care Specialists. Together, we're building a stronger, more connected healthcare system ... This will include development of UM policies and procedures,identifyingthe type of criteria to be ...

Independent Health Association

$115 - $155/hr

... Medical Specialists (ABMS), preferably in Primary Care (internal medicine, family practice, etc ... Ability to rotate in UM call schedule to remotely cover evenings, weekends and holidays.

OncoHealth

Utilization Management (UM) Trainer

The UM Trainer partners with operations, quality, compliance, and leadership teams to identify ... Create consolidated training materials and framework for onboarding of CRS (Case Review Specialist ...

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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 Sep 5, 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 100% Full Time. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $57,372 per year, or $27.6 per hour.

Utilization Management (UM) Clinical Support Specialist (Remote)

Tango Care

Phoenix, AZ • On-site, Remote

Full-time

Re-posted 7 days ago

Job description

Description
tango is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care.
We are currently looking for a UM Clinical Support Specialist to join our growing team!
** This is a Non-Clinical role and Clinicians will not be considered **
The UM Clinical Support Specialist plays a vital role in supporting the leadership of the Utilization Management team by collecting, analyzing, and reporting data. This position is responsible for maintaining utilization and productivity logs, developing, and monitoring reports, and ensuring accurate and timely documentation. The role also provides administrative support to the clinical team by managing inbound and outbound calls that do not require clinical intervention, review referrals for completeness, assisting reviewers with obtaining clinical information when needed, and supporting compliance, training, and appeal processes
Office Location:
  • Office located at 2415 E Camelback Road, Suite 700, Phoenix, AZ 85020
  • Remote (MST or PST time zone)

Essential Functions:
  • Works independently with minimal supervision and demonstrates accountability for work quality.
  • Support the UM Director and Supervisor in data collection and analysis.
  • Creates and manage comprehensive reports on utilization and productivity and performance trends.
  • Reviews the human resource credentialing reports with the Supervisor to ensure clinician licenses remain current in all applicable states.
  • Monitors Relias for completion of mandatory training and ensure staff compliance within required timelines.
  • Records and tracks QIO appeal requests and provides assistance as needed.
  • Assists the clinical team by managing non-clinical calls, inquires and administrative tasks.
  • Assists the clinical team by reviewing referrals for missing clinical documentation and obtaining clinical information from providers or facilities when necessary and providing decision notifications back to the providers.
  • Assist UM reviewers with administrative tasks in relation to the PA/RA/Appeals process.
  • Assist UM department with non-clinical RA decisions.
  • Answers and resolves portal tickets in a timely manner.
  • Maintains accurate logs, tracks data trends and identifies opportunities for process improvements.
  • Exhibits a professional, pleasant and welcoming demeanor both in person and on the phone.
  • Schedules 1:1 meetings for leadership and staff as directed.
  • Other duties as assigned.

Qualifications:
  • Associate degree in healthcare administration, business administration, or a related field required; Bachelor's degree preferred.
  • Proven experience in a healthcare support role, particularly in data collection and reporting.
  • Prior experience supporting clinical teams and handling administrative tasks related to healthcare services.

Knowledge and Experience:
  • Proficiency in relevant software applications (e.g., Excel, Power BI, database management systems).
  • General medical knowledge.
  • Understanding of healthcare utilization management processes and terminology.
  • Awareness of privacy regulations and data security practices in healthcare.
  • Excellent organizational skills with strong attention to detail.
  • Critical thinking and troubleshooting skills.
  • Ability to manage multiple tasks and prioritize effectively in a fast-paced environment.
  • Well-developed interpersonal and communication skills.
  • Professional appearance and manner.
  • Ability to work both independently and collaboratively in a team environment.

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

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