The Care Manager, under the direction of the Vice President of Clinical Services, is primarily ... Informs member and provider of Utilization Management determinations and treatment alternatives ...
The Care Manager, under the direction of the Vice President of Clinical Services, is primarily ... Informs member and provider of Utilization Management determinations and treatment alternatives ...
The Care Manager, under the direction of the Vice President of Clinical Services, is primarily ... Informs member and provider of Utilization Management determinations and treatment alternatives ...
The Care Manager, under the direction of the Vice President of Clinical Services, is primarily ... Informs member and provider of Utilization Management determinations and treatment alternatives ...
This role involves coordinating care and managing service utilization for patients in acute and post-acute skilled settings. You will collaborate closely with interdisciplinary teams both inside and ...
This role involves coordinating care and managing service utilization for patients in acute and post-acute skilled settings. You will collaborate closely with interdisciplinary teams both inside and ...
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for ... Assists nurse Care Managers in communicating with the patient denied hospital days as well as the ...
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for ... Assists nurse Care Managers in communicating with the patient denied hospital days as well as the ...
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for ... Assists nurse Care Managers in communicating with the patient denied hospital days as well as the ...
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for ... Assists nurse Care Managers in communicating with the patient denied hospital days as well as the ...
The Care Manager actively participates in the utilization management process using standards of care to determine the most appropriate level of care, managing care across the continuum to ensure a ...
The Care Manager actively participates in the utilization management process using standards of care to determine the most appropriate level of care, managing care across the continuum to ensure a ...
Care Manager
Shreveport, LA · On-site
The role of the Care Manager is to coordinate and manage care throughout the patient's acute inpatient illness; ensure continuity of services and appropriate utilization and management of resources.
Care Manager
Shreveport, LA · On-site
The role of the Care Manager is to coordinate and manage care throughout the patient's acute inpatient illness; ensure continuity of services and appropriate utilization and management of resources.
Care Manager
Shreveport, LA · On-site
The role of the Care Manager is to coordinate and manage care throughout the patient's acute inpatient illness; ensure continuity of services and appropriate utilization and management of resources.
Care Manager
Shreveport, LA · On-site
The role of the Care Manager is to coordinate and manage care throughout the patient's acute inpatient illness; ensure continuity of services and appropriate utilization and management of resources.
Care Manager
Saint Joseph, MO · On-site
The Care Manager works under the supervision of leadership providing coordination of care for ... Utilization data, Quality data, Clinical indicators, etc) utilizing electronic tools, reports, and ...
Care Manager
Saint Joseph, MO · On-site
The Care Manager works under the supervision of leadership providing coordination of care for ... Utilization data, Quality data, Clinical indicators, etc) utilizing electronic tools, reports, and ...
Supervisor, Utilization Management
Brick, NJ · On-site
$107K/yr
The Supervisor, Care Management role integrates and coordinates utilization management, care ... Develops the performance improvement plan of the care manager, documents performance and provides ...
Supervisor, Utilization Management
Brick, NJ · On-site
$107K/yr
The Supervisor, Care Management role integrates and coordinates utilization management, care ... Develops the performance improvement plan of the care manager, documents performance and provides ...
The Supervisor, Care Management role integrates and coordinates utilization management, care ... Develops the performance improvement plan of the care manager, documents performance and provides ...
The Supervisor, Care Management role integrates and coordinates utilization management, care ... Develops the performance improvement plan of the care manager, documents performance and provides ...
The Care Manager actively participates in the utilization management process using standards of care to determine the most appropriate level of care, managing care across the continuum to ensure a ...
The Care Manager actively participates in the utilization management process using standards of care to determine the most appropriate level of care, managing care across the continuum to ensure a ...
CARE MANAGER
$68 - $72/hr
The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and service.
CARE MANAGER
$68 - $72/hr
The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and service.
CARE MANAGER
Daly City, CA · On-site
$68/hr
Overview The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and ...
CARE MANAGER
Daly City, CA · On-site
$68/hr
Overview The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and ...
CARE MANAGER
Daly City, CA · On-site
Overview The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and ...
CARE MANAGER
Daly City, CA · On-site
Overview The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and ...
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for ... Assists nurse Care Managers in communicating with the patient denied hospital days as well as the ...
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for ... Assists nurse Care Managers in communicating with the patient denied hospital days as well as the ...
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for ... Assists nurse Care Managers in communicating with the patient denied hospital days as well as the ...
The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for ... Assists nurse Care Managers in communicating with the patient denied hospital days as well as the ...
The Inpatient Care Manager, in collaboration with the clinical team and medical provider, provides ... The Care Manger strives to promote patient wellness, improved care outcomes, efficient utilization ...
The Inpatient Care Manager, in collaboration with the clinical team and medical provider, provides ... The Care Manger strives to promote patient wellness, improved care outcomes, efficient utilization ...
Care Manager
$80K - $86K/yr
Participates in the utilization management process using standards of care to determine the most ... appropriate level of care, managing care across the continuum to ensure a safe discharge in a ...
Care Manager
$80K - $86K/yr
Participates in the utilization management process using standards of care to determine the most ... appropriate level of care, managing care across the continuum to ensure a safe discharge in a ...
Care Manager
Shreveport, LA · On-site
Coordinate and manage care throughout the patient's acute inpatient illness; ensure continuity of services and appropriate utilization and management of resources. Demonstrate leadership abilities by ...
Care Manager
Shreveport, LA · On-site
Coordinate and manage care throughout the patient's acute inpatient illness; ensure continuity of services and appropriate utilization and management of resources. Demonstrate leadership abilities by ...
Utilization Care Manager information
See salary details
$39K - $50.7K
9% of jobs
$59.3K is the 25th percentile. Wages below this are outliers.
$50.7K - $62.4K
22% of jobs
$62.4K - $74K
11% of jobs
The median wage is $81.2K / yr.
$74K - $85.7K
14% of jobs
$85.7K - $97.4K
12% of jobs
$104.7K is the 75th percentile. Wages above this are outliers.
$97.4K - $109.1K
13% of jobs
$109.1K - $120.8K
13% of jobs
$120.8K - $132.5K
5% of jobs
$132.5K - $144.1K
2% of jobs
$144.1K - $155.8K
0% of jobs
$155.8K - $167.5K
0% of jobs
$39K
$91K
$167.5K
How much do utilization care manager jobs pay per year?
As of Jul 13, 2026, the average yearly pay for utilization care manager in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 per year, depending on experience, location, and employer.
What does a utilization manager do?
A utilization care manager evaluates healthcare services to ensure they are necessary, appropriate, and cost-effective. They review patient cases, coordinate with healthcare providers, and use medical records and guidelines to optimize resource use and improve patient outcomes.
How does a Utilization Care Manager typically collaborate with medical and administrative teams to ensure effective patient care?
Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.
What are Utilization Care Managers?
Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.
Is being a MOA a good entry level job?
A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience in patient communication, medical records, and office procedures, which can serve as a foundation for advanced healthcare roles. However, career growth may require additional certifications or training.
What jobs pay 4000 a week without a degree?
Utilization Care Managers typically do not earn $4,000 weekly without specialized experience or certifications. High-paying roles that can reach this level without a degree often include skilled trades such as commercial pilots, real estate brokers, or sales managers, which may require licensing or extensive experience. Most jobs paying this amount without a degree involve specialized skills, certifications, or significant experience in the field.
What are the key skills and qualifications needed to thrive as a Utilization Care Manager, and why are they important?
To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.
What is the difference between Utilization Care Manager vs Utilization Review Nurse?
| Aspect | Utilization Care Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, case management certification | RN, certification in utilization review |
| Work Environment | Healthcare facilities, insurance companies | Hospitals, insurance companies, outpatient clinics |
| Primary Focus | Coordinating patient care, managing resources | Reviewing medical necessity, approving treatments |
Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.
What is the highest paying healthcare administration job?
In healthcare administration, executive roles such as Chief Executive Officer (CEO), Chief Operating Officer (COO), and Chief Financial Officer (CFO) tend to have the highest salaries, often exceeding six figures annually. These positions require extensive experience, leadership skills, and often advanced degrees like an MBA or healthcare administration certification.
More about Utilization Care Manager jobs
What cities are hiring for Utilization Care Manager jobs? Cities with the most Utilization Care Manager job openings:
What states have the most Utilization Care Manager jobs? States with the most job openings for Utilization Care Manager jobs include:
What job categories do people searching Utilization Care Manager jobs look for? The top searched job categories for Utilization Care Manager jobs are:
Care Manager - Utilization Management (Must Have UAS Experience)
Manhattan, NY • On-site
$112K/yr
Full-time
Re-posted 17 days ago
MetroPlusHealth rating
7.8
Based on 5 frontline employees who took The Breakroom Quiz
169th of 281 rated insurance
Job description
Position Overview
Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Care Manager, under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.
Duties & Responsibilities
• Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established MetroPlusHealth Utilization Management policies, procedures, and protocols.
• Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
• Interacts and obtains relevant clinical information from members' PCP and other providers; approves care that meets established criteria; and refers all other cases to the MetroPlusHealth Physician Advisor/Medical Director. Informs member and provider of Utilization Management determinations and treatment alternatives.
• Identifies utilization trends and potential member needs by means of generating reports of encounter data, pharmacy data review, and new member health assessment forms.
• Evaluate member needs for referred cases (from providers or member self-referred).
• Assists all departments with the resolution of members' problems related to utilization management issues.
• Performs all Utilization Management activities in compliance with all regulatory agency requirements.
• Conducts medical record reviews as appropriate to case management functions.
• Participate in Medical Management grand rounds with the Physician Advisor.
• Performs all other duties as assigned
Minimum Qualifications
• New York State license as Registered Nurse, License Practical Nurse, or Physical Therapist required
• High School Diploma General Equivalency Diploma (GED) required; and
• 2-5 years' clinical experience in an acute or applicable care setting.
• UM/UR experience in managed care or hospital setting required.
Professional Competencies
• Integrity and Trust
• Customer Focus
• Excellent communication, written and analytical skills.
• Knowledge of computer systems.
#LI-REMOTE
#MPH-50
Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Care Manager, under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.
Duties & Responsibilities
• Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established MetroPlusHealth Utilization Management policies, procedures, and protocols.
• Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
• Interacts and obtains relevant clinical information from members' PCP and other providers; approves care that meets established criteria; and refers all other cases to the MetroPlusHealth Physician Advisor/Medical Director. Informs member and provider of Utilization Management determinations and treatment alternatives.
• Identifies utilization trends and potential member needs by means of generating reports of encounter data, pharmacy data review, and new member health assessment forms.
• Evaluate member needs for referred cases (from providers or member self-referred).
• Assists all departments with the resolution of members' problems related to utilization management issues.
• Performs all Utilization Management activities in compliance with all regulatory agency requirements.
• Conducts medical record reviews as appropriate to case management functions.
• Participate in Medical Management grand rounds with the Physician Advisor.
• Performs all other duties as assigned
Minimum Qualifications
• New York State license as Registered Nurse, License Practical Nurse, or Physical Therapist required
• High School Diploma General Equivalency Diploma (GED) required; and
• 2-5 years' clinical experience in an acute or applicable care setting.
• UM/UR experience in managed care or hospital setting required.
Professional Competencies
• Integrity and Trust
• Customer Focus
• Excellent communication, written and analytical skills.
• Knowledge of computer systems.
#LI-REMOTE
#MPH-50
About MetroPlusHealth
Sourced by ZipRecruiter
Industry
Insurance services
Company size
1,001 - 5,000 Employees
Headquarters location
New York, NY, US