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Utilization Management Auditor Jobs (NOW HIRING)

Samaritan Daytop Village

Utilization Manager

Queens, NY · On-site

$34.61 - $38.46/hr

Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.

Samaritan Daytop Village

Utilization Manager

Queens, NY · On-site

$34.61 - $38.46/hr

Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.

Samaritan Daytop Village

Utilization Manager

Queens, NY · On-site

$34.61 - $38.46/hr

Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... auditing. * Performs other duties as assigned. Who You Will Be * High School Diploma or GED ...

Vantage Search Group

RN - Utilization Management needed at Mountain Home Air Force Base in Mountain Home, Idaho. Duties ... Coders/Coding Auditors, Population Health Nurse Consultants, Medical Management, Referral ...

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Utilization Management Auditor information

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How much do utilization management auditor jobs pay per hour?

As of Jun 22, 2026, the average hourly pay for utilization management auditor in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.

What is the difference between Utilization Management Auditor vs Utilization Review Nurse?

AspectUtilization Management AuditorUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications like CCM or CUCLicensed Registered Nurse (RN), often with additional certifications
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinics, insurance companies, often in clinical settings
Primary FocusAuditing and reviewing utilization data for compliance and cost managementAssessing patient care needs and determining appropriate services

While both roles involve healthcare utilization, the Utilization Management Auditor primarily reviews data for compliance and cost efficiency, whereas the Utilization Review Nurse focuses on patient care assessments. Both require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ.

What are some common challenges faced by Utilization Management Auditors and how can they be addressed?

Utilization Management Auditors often encounter challenges such as keeping up with constantly changing healthcare regulations and payer requirements, interpreting complex medical documentation, and ensuring compliance with both internal and external policies. To address these challenges, auditors should engage in ongoing professional development, collaborate closely with clinical and administrative teams for accurate information, and make use of robust audit tools and resources. Effective communication and a proactive approach to regulatory changes can help streamline the audit process and maintain high standards of accuracy.

What is a utilization management auditor?

A utilization management auditor reviews healthcare claims and medical records to ensure that services are medically necessary and compliant with insurance policies. They analyze documentation, apply clinical guidelines, and often work with healthcare providers and insurance companies to approve or deny coverage requests.

What is the highest paying job in health information management?

In health information management, the highest paying roles often include Health Information Directors, Chief Medical Information Officers, and Data Analytics Managers, with salaries exceeding $100,000 annually. These positions typically require advanced certifications, extensive experience, and strong leadership skills in managing health data systems and compliance.

How do you get into utilization management?

To become a utilization management auditor, candidates typically need a background in healthcare, nursing, or health administration, along with knowledge of medical coding and insurance processes. Relevant certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Certified Coding Specialist (CCS) can enhance prospects. Gaining experience in clinical review, claims processing, or case management is also beneficial for entering the field.

Is an auditor a high paying job?

Utilization Management Auditors typically earn salaries that are competitive within the healthcare and insurance industries, with pay varying based on experience, location, and certifications. While some auditing roles offer high salaries, they generally do not reach the highest levels of compensation compared to executive or specialized technical positions.

What are the key skills and qualifications needed to thrive as a Utilization Management Auditor, and why are they important?

To thrive as a Utilization Management Auditor, you need a strong background in healthcare administration, case management, and medical coding, often supported by a clinical degree or certification such as RN, LPN, or RHIA. Familiarity with utilization management software, electronic health records (EHRs), and regulatory standards like CMS guidelines is essential. Analytical thinking, attention to detail, and effective communication are crucial soft skills for identifying compliance issues and collaborating with healthcare teams. These skills ensure accurate audits, regulatory compliance, and optimal resource utilization within healthcare organizations.
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Utilization Management Auditor jobs near you
Infographic showing various Utilization Management Auditor job openings in the United States as of June 2026, with employment types broken down into 96% Full Time, and 4% Temporary. Highlights an 83% In-person, 4% Hybrid, and 13% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.

Weekend RN Coordinator Utilization Management (1.0 FTE)

Network Health, Inc

Menasha, WI • On-site

Full-time

Posted 17 days ago

Job description

The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Training is required in person at our Menasha location for the first 6-8 weeks, Monday through Friday 8am - 5pm.

Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Saturday and Sunday core hours, weekdays available to make up remaining 40 hours. August - September 2026 start date.

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

  • Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers
  • Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication
  • Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff
  • Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files)
  • Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment
  • Collaborate with other NH departments to develop interdepartmental operational processes
  • Support Utilization Management department programs and goals through active participation
  • Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria
  • Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability
  • Evaluate cases for cost savings/quality improvement potential
  • Other duties and responsibilities as assigned

Job Requirements:

  • Bachelor of Science in Nursing, preferred
  • Associate Degree in Nursing, required
  • Current registered nurse licensure in Wisconsin required
  • Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
  • Experience in insurance, managed care and utilization management preferred

Network Health is an Equal Opportunity Employer

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