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Utilization Management Associate Jobs (NOW HIRING)

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $62.32/hr

Associate Degree in Nursing Nice to Have * Utilization Management or Prior Authorization experience * Managed care background * Familiarity with MedCompass * Ambulatory surgery experience * BSN ...

Humana

Manager, Utilization Management Nursing

Utilization management * Prior experience within discharge planning, case management * Health Plan ... Humana reserves the right to require associates to upgrade their internet service if necessary.

Humana

Manager, Utilization Management Nursing

Utilization management * Prior experience within discharge planning, case management * Health Plan ... Humana reserves the right to require associates to upgrade their internet service if necessary.

Humana

Manager, Utilization Management Nursing

Utilization management * Prior experience within discharge planning, case management * Health Plan ... Humana reserves the right to require associates to upgrade their internet service if necessary.

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $56.14/hr

... Associates Degree required BSN preferred Work from Home Requirements: You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a ...

CVS Health

Utilization Management Nurse Consultant

$26.01 - $62.32/hr

Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours Associate Degree in Nursing Nice to Have Utilization Management or Prior Authorization experience ...

UMR

Utilization Management Nurse | Square, |

$60K - $107K/yr

Utilization Management Nurse Optum is a global organization that delivers care, aided by technology ... Associate's degree * Unrestricted Registered Nurse license in your state of residence * 3+ years of ...

Corewell Health

Utilization Mgmt Spec

Southfield, MI · On-site

Preferred * Post high school training and/or academic coursework leading toward associate or ... Name Utilization Management - Diversified East WB Mkt Employment Type Part time Shift Day (United ...

Spectrum Health

Utilization Mgmt Spec

Southfield, MI · On-site

Preferred * Post high school training and/or academic coursework leading toward associate or ... Name Utilization Management - Diversified East WB Mkt Employment Type Part time Shift Day (United ...

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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 Registered Nurse

Madera, CA • On-site

Valley Children's Healthcare
Hospitals • 1 - 5K employees
Learn more about Valley Children's Healthcareexternal

$57.29 - $81.72/day

Other

Re-posted 12 days ago

Valley Children's Hospital rating

6.4

Company rating: 6.4 out of 10

Based on 14 frontline employees who took The Breakroom Quiz

Job description

Job Summary:
The Utilization Management Nurse supports the case management department by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria, active involvement in denial management, acting as a resource to staff regarding clinical criteria, communication with payors to address concerns and other duties as assigned. The Utilization Management Nurse will work collaboratively with the Utilization Nurse Program Coordinator to ensure compliance with regulatory, organizational and department requirements. The Utilization Review Nurse will receive direction from the Utilization Review Program Coordinator for daily and long term tasks and projects.
Qualifications:
Education
  • Associates Degree Nursing (required)
  • Bachelors Degree Nursing or related field (preferred)
Licenses and Certifications
  • RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing (required)
Work Experience
  • Minimum three (3) years Full time equivalent RN experience in an acute care hospital. (required)
  • Pediatric experience and experience in Case Management and/or Utilization Review. (preferred)
Skills and Abilities
  • Knowledge of UM regulations.
    Knowledge of private and public payer reimbursement practices and procedures.
    Excellent organizational and communication skills and ability to work with a variety of health care professionals.
    Ability to work independently.
  • Computer Skills Proficiency with word processing, spreadsheets and database software.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Compensation Range:
$57.29 - $81.72
Workshift:
Day (United States of America)
Position Exempt:
No
FTE %:
90
Scheduled Weekly Hours:
36
Daily Hours:
8
Have Questions?
Call Recruitment Services at 559-353-7071 or email us at recruiting@valleychildrens.org
Disclaimer: Final compensation will be dependent upon skills and experience.

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