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Utilization Management Assistant Jobs in Pennsylvania

Acadia Healthcare

Utilization Specialist

Allenwood, PA · On-site

Act as liaison between managed care organizations and the facility professional clinical staff ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

Acadia Healthcare

Utilization Specialist

Moosic, PA · On-site

Act as liaison between managed care organizations and the facility professional clinical staff ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

Harboroaks

Utilization Specialist

Allenwood, PA · On-site

$65 - $85/hr

Act as liaison between managed care organizations and the facility professional clinical staff ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

New

Acadia Healthcare

Utilization Specialist

Moosic, PA · On-site

Act as liaison between managed care organizations and the facility professional clinical staff ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

Acadia Healthcare

Utilization Specialist

Allenwood, PA · On-site

Act as liaison between managed care organizations and the facility professional clinical staff ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

Meadville Medical Center

UM COORDINATOR

Meadville, PA · On-site

... Assist Director of Utilization Management by creating meeting invites, PowerPoints, and work orders as needed. Will also assist Director with different case issues that come up throughout the day ...

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Utilization Management Assistant information

See Pennsylvania salary details

$29.1K

$48.5K

$69.7K

How much do utilization management assistant jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization management assistant in Pennsylvania is $48,513.00, according to ZipRecruiter salary data. Most workers in this role earn between $42,100.00 and $48,600.00 per year, depending on experience, location, and employer.

What is a utilization management assistant?

A Utilization Management Assistant is a healthcare administrative professional who supports the utilization management team by handling clerical tasks, coordinating communications, and organizing patient documentation. They often help ensure that medical services are used efficiently and that insurance requirements are met by gathering information, processing authorizations, and maintaining records. This role is essential in facilitating collaboration between healthcare providers, insurance companies, and patients, ultimately helping to optimize the quality and cost-effectiveness of patient care.

What are the key skills and qualifications needed to thrive as a utilization management assistant?

To thrive as a Utilization Management Assistant, you need a solid understanding of healthcare processes, medical terminology, and administrative procedures, often supported by a high school diploma or associate's degree. Familiarity with electronic health records (EHR) systems, insurance verification tools, and Microsoft Office Suite is typically required. Strong organizational skills, attention to detail, and effective communication are crucial soft skills for managing documentation and collaborating with clinical teams. These skills ensure accurate data handling, efficient workflow, and compliance with healthcare regulations, all of which are vital for successful utilization management operations.

What are some common challenges utilization management assistants face when working with insurance pre-authorizations?

Utilization Management Assistants often encounter challenges such as navigating complex insurance requirements, meeting tight deadlines for pre-authorization requests, and communicating effectively with both healthcare providers and insurance representatives. Staying organized and detail-oriented is essential to ensure all documentation is accurate and submitted promptly. Additionally, adapting to frequent changes in insurance policies and maintaining strong problem-solving skills are key to overcoming these obstacles.

Is utilization management assistant a good job?

Utilization Management Assistants support healthcare organizations by reviewing medical records and authorizations to ensure appropriate care and cost management. The role typically requires attention to detail, knowledge of healthcare policies, and proficiency with electronic health records systems. It can offer stable employment with opportunities for advancement in healthcare administration.

What are the most commonly searched types of Utilization Management jobs in Pennsylvania?

The most popular types of Utilization Management jobs in Pennsylvania are:

What cities in Pennsylvania are hiring for Utilization Management Assistant jobs?

Cities in Pennsylvania with the most Utilization Management Assistant job openings:

Utilization Management Assistant jobs near you
Infographic showing various Utilization Management Assistant job openings in Pennsylvania as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $48,513 per year, or $23.3 per hour.

Utilization Review Nurse Corporate UM

Pennsylvania Medicine

Bala Cynwyd, PA • On-site

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Penn Medicine rating

7.5

Company rating: 7.5 out of 10

Based on 353 frontline employees who took The Breakroom Quiz

232nd of 898 rated healthcare providers

Job description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Entity: Corporate Services
Department: Corp Utilization Management
Location: Bala Cynwyd, PA/ remote
Summary:
The Utilization Review Nurse is responsible for conducting timely and accurate utilization review activities to support appropriate patient status determination, medical necessity review, and compliance with regulatory and payer requirements. This role applies clinical expertise and evidence-based criteria to evaluate the appropriateness of admissions, continued stays, and resource utilization while promoting quality patient care and efficient use of healthcare resources.
Working within Penn Medicine's centralized Utilization Management department the Utilization Review Nurse collaborates with physicians, Physician Advisors, case management, revenue cycle, and interdisciplinary care teams to facilitate appropriate level-of-care determinations, authorization management, denial prevention, and compliance with federal, state, accreditation, and payer requirements.
Responsibilities:

  • Conduct medical necessity reviews and patient status determinations using approved clinical criteria, regulatory requirements, and organizational policies.
  • Perform admission, concurrent, continued stay, and retrospective utilization reviews to ensure appropriate level of care and resource utilization.
  • Manage payer authorization and notification processes to promote timely approvals and reduce financial risk.
  • Identify and escalate cases that require secondary review, physician advisor involvement, or additional clinical documentation.
  • Collaborate with physicians, case managers, social workers, and interdisciplinary teams to support appropriate patient progression, discharge planning, and utilization management goals.
  • Ensure accurate and timely documentation of utilization review activities, authorization determinations, and payer communications within designated systems.
  • Assist with denial prevention activities through proactive identification of medical necessity, documentation, authorization, and patient status concerns.
  • Monitor and maintain compliance with CMS regulations, payer requirements, accreditation standards, organizational policies, and utilization management workflows.
  • Performs duties in accordance with Penn Medicine and entity values, policies, and procedures
  • Other duties as assigned to support the unit, department, entity, and health system organization UPHS Organizational
Credentials:
  • Registered Nurse is required.
  • Certified Case Manager (CCM) or Accredited Case Manager (ACM) is preferred.
Education or Equivalent Experience:
  • Bachelor's degree is required.
  • 2+ years of Acute Hospital Care experience is required.
  • Experience with Interqual and MCG is preferred.
  • Previous Utilization Management, Appeals, or Denials Management experience is preferred.
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

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