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Utilization Management Jobs (NOW HIRING)

Intus, Inc

Utilization Management Nurse

$80K - $95K/yr

Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual ...

Wellpath

Director Utilization Mgmt

Lemoyne, PA · On-site

Overview The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within their assigned ...

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Utilization Management information

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$39K

$89.5K

$163K

How much do utilization management jobs pay per year?

As of Jul 19, 2026, the average yearly pay for utilization management in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Utilization Management position, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What is a Utilization Management job?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a Utilization Management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

More about Utilization Management jobs
What cities are hiring for Utilization Management jobs? Cities with the most Utilization Management job openings:
What are the most commonly searched types of Utilization Management jobs? The most popular types of Utilization Management jobs are:
What states have the most Utilization Management jobs? States with the most job openings for Utilization Management jobs include:
What job categories do people searching Utilization Management jobs look for? The top searched job categories for Utilization Management jobs are:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.
RN, Utilization Management | Utilization Management

RN, Utilization Management | Utilization Management

UF Health

The Villages, FL • On-site

Full-time

Posted 24 days ago

Job description

Overview
Join an onsite clinical team focused on ensuring the right care at the right time for every patient.
Work Style: Onsite
Location: The Villages, FL
FTE: Full-Time (1.0 FTE)
Schedule: Monday - Friday (occasional weekends required)
Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization.
Communicates authorization decisions clearly and monitors patient progress to support timely discharge planning. Analyzes utilization data to identify trends and opportunities for process improvement.
Partners with interdisciplinary teams to enhance care coordination, ensure accurate documentation, and maintain compliance with regulatory and organizational standards.
Responsibilities
Key Responsibilities
  • Evaluates patient medical records to ensure the necessity and appropriateness of healthcare services.
  • Coordinates with healthcare providers to ensure compliance with utilization management guidelines.
  • Supports the optimization of treatment plans to promote effective patient care and appropriate resource utilization.
  • Communicates authorization decisions clearly and supports timely discharge planning.
  • Analyzes utilization data to identify trends and opportunities to improve care coordination.
  • Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.

Qualifications
Education & Experience:
Registered Nurse (RN) with a current Florida license required.
  • Three (3) years of critical care nursing experience, or
  • Five (5) years of medical-surgical nursing experience, or
  • Three (3) years of utilization review, case management, or third-party payer experience.

Qualifications
  • Active Registered Nurse (RN) license with 3+ years of experience in utilization review or case management.
  • Strong knowledge of healthcare utilization management guidelines and regulatory compliance.
  • Experience evaluating medical necessity and optimizing treatment plans.
  • Excellent communication skills with the ability to clearly convey authorization decisions.
  • Ability to analyze utilization data and support effective care coordination.
  • Strong organizational skills with the ability to manage multiple priorities simultaneously.
  • Ability to work independently and collaboratively with multidisciplinary teams.
  • Strong attention to detail and innovative problem-solving skills.
  • Flexibility to adjust work hours and days based on departmental needs.

Motor Vehicle Operator Designation:
Employees in this position will not operate vehicles for an assigned business purpose.
Note: Please indicate the appropriate operator designation on the Request for Personnel (RFP) form at the time of submission.
Licensure/Certification/Registration:
  • Registered Nurse (RN) with a current Florida license required.

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