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Utilization Management Associate Jobs (NOW HIRING)

Humana

Utilization Management Nurse

Associate's Degree * Licensed Registered Nurse (RN) with compact license in the (appropriate state ... Experience in utilization management * Claims experience * Leadership experience Additional ...

Minnesota Jobs

Utilization Management Nurse

Associate's Degree * Licensed Registered Nurse (RN) with compact license in the (appropriate state ... Experience in utilization management * Claims experience * Leadership experience Additional ...

Humana

Utilization Management Nurse

Associate's Degree * Licensed Registered Nurse (RN) with compact license in the (appropriate state ... Experience in utilization management * Claims experience * Leadership experience Additional ...

Humana

Utilization Management Nurse

Associate's Degree * Licensed Registered Nurse (RN) with compact license in the (appropriate state ... Experience in utilization management * Claims experience * Leadership experience Additional ...

Oak St. Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

Associate Degree in Nursing. * Strong communication, multitasking, and computer navigation skills ... Managed Care and/or Utilization Management experience. * Candidates located in the Eastern Time ...

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Utilization Management Associate information

What does a utilization management associate do?

A Utilization Management Associate is responsible for reviewing healthcare services and determining whether they are medically necessary, appropriate, and efficient. They work with healthcare providers, insurance companies, and patients to ensure that treatments comply with established guidelines and policies. Their role often includes reviewing medical records, processing authorizations, and assisting in the coordination of care to optimize the use of healthcare resources. This position helps control costs while ensuring that patients receive the appropriate level of care.

What skills and qualifications are needed to thrive as a utilization management associate?

A Utilization Management Associate typically needs a background in healthcare administration or a related field, strong analytical skills, and knowledge of medical terminology and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and regulatory compliance systems is important, and certifications like Certified Professional in Healthcare Management (CPHM) can be advantageous. Attention to detail, effective communication, and strong organizational skills help associates excel in evaluating medical necessity and collaborating with care teams. These competencies ensure accurate, efficient review processes that support quality patient care and compliance with payer requirements.

What are the typical daily responsibilities of a utilization management associate?

Utilization Management Associates typically review medical records, verify insurance coverage, and coordinate with healthcare providers to ensure that treatments and services meet established guidelines and payer requirements. They also communicate with physicians and patients to gather necessary information for authorization requests. By ensuring appropriate utilization of healthcare resources, they help support patient care while managing costs and compliance for their organization. Collaboration with clinical staff and insurance representatives is a key part of the role, contributing to effective case management.

What is the difference between Utilization Management Associate vs Utilization Review Coordinator?

AspectUtilization Management AssociateUtilization Review Coordinator
CertificationsTypically requires a healthcare-related certification or licenseOften requires similar certifications, such as CCM or RHIA
Work EnvironmentWorks in insurance companies, healthcare providers, or managed care organizationsWorks in hospitals, insurance companies, or healthcare facilities
Job FocusAssists in reviewing medical necessity and authorization processesCoordinates and conducts utilization reviews and approvals
Common UsageUsed interchangeably in healthcare and insurance settingsOften used in hospital and insurance contexts

The Utilization Management Associate and Utilization Review Coordinator roles share similarities in certifications and work environments, focusing on reviewing medical necessity and authorization. The main difference lies in their specific responsibilities, with associates assisting in the process and coordinators actively conducting reviews and approvals.

What cities are hiring for Utilization Management Associate jobs?

Cities with the most Utilization Management Associate 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 Associate jobs?

States with the most job openings for Utilization Management Associate jobs include:

What are popular job titles related to Utilization Management Associate jobs?

For Utilization Management Associate jobs, the most frequently searched job titles are:

Infographic showing various Utilization Management Associate job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution.

Utilization Management Assoc / Clinical Resource Management

Wethersfield, CT • On-site

Hartford HealthCare at Home
Health Care and Social Assistance • 201 - 500 employees
Learn more about Hartford HealthCare at Homeexternal

$65K - $90K/yr

Other

Posted 19 days ago

Job description

Utilization Management Assoc / Clinical Resource Management

Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization. Integrated Care Partners (ICP) is a physician-led, clinically integrated health care network whose mission is to assist our members in providing the highest quality care at the most reasonable cost for our patients in the current, rapidly changing medical environment.

Position Summary: The Clinical Resource Management Associate is an integral part of the Care Management team. The Clinical Resource Management Associate's focus is on providing support and coordination of utilization management services for the utilization management department.

Position Responsibilities:

  • Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization Management list, Discharge Log, and the Discharge Disposition report for payers.
  • Monitors and manages assigned EPIC work queues.
  • Updates EPIC with authorization and denial information.
  • Provides the Clinical Resource Management Nurse with support for denials, appeals, and physician advisor communication.
  • Retrieves, manages and/or triages department phone calls, voicemails, fax requests and Tiger Texts.
  • Communicates with payers, case management, medical records, and other departments.
  • Scans and uploads documentation into the electronic health records.
  • Performs routine and administrative tasks within the scope of non-licensed personnel.
  • Manages Certification Email process.
  • Other duties as assigned by supervisor

Qualifications:

United States Regular Standard Hours Per Week: 32 Schedule: Part-time (2 - 39 hours) Shift Details: Monday thru Friday hours - during 1st shift, no holidays or weekends.

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About Hartford HealthCare at Home

Sourced by ZipRecruiter

Hartford HealthCare at Home, based in Wethersfield, Connecticut, US, is a premier provider in the healthcare industry, specifically in home-based care services. Their official website can be accessed at hartfordhealthcareathome.org. They offer a wide range of services including nursing, physical therapy, occupational therapy, speech therapy, social work, and home health aid. The company was established with the mission to enhance the capability of people to achieve optimal health and wellbeing through its home care services. They maintain a patient-centric approach and belief in making a real difference in people's lives. As an integral part of Hartford HealthCare, they share the vision to be “most trusted for personalized coordinated care”.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Wethersfield, CT, US

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