Monthly auditing of Compliance Risk areas and identification of staff education and documentation ... Utilization Management experience highly preferred. * Education and/or training experience highly ...
Monthly auditing of Compliance Risk areas and identification of staff education and documentation ... Utilization Management experience highly preferred. * Education and/or training experience highly ...
... • Monthly auditing of Compliance Risk areas and identification of staff education and ... Utilization Management experience highly preferred. * Education and/or training experience highly ...
... • Monthly auditing of Compliance Risk areas and identification of staff education and ... Utilization Management experience highly preferred. * Education and/or training experience highly ...
Sr Mgr-Utilization Mgmt
Houston, TX · On-site
$107.60K - $134.50K/yr
Responsible to ensure the auditing of staff monthly, and as needed to maintain compliance with ... Understand the Utilization Review process including census management. Experienced with medical ...
Sr Mgr-Utilization Mgmt
Houston, TX · On-site
$107.60K - $134.50K/yr
Responsible to ensure the auditing of staff monthly, and as needed to maintain compliance with ... Understand the Utilization Review process including census management. Experienced with medical ...
... Utilization Management (UM) programs including prior authorization, concurrent inpatient and ... auditing and implementing UM program policies consistent with contractual and performance ...
... Utilization Management (UM) programs including prior authorization, concurrent inpatient and ... auditing and implementing UM program policies consistent with contractual and performance ...
Utilization Manager
Rhinebeck, NY · On-site
$32.96 - $37.48/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Rhinebeck, NY · On-site
$32.96 - $37.48/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Rhinebeck, NY · On-site
$35.71 - $43.31/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Rhinebeck, NY · On-site
$35.71 - $43.31/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Rhinebeck, NY · On-site
$35.71 - $43.31/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Rhinebeck, NY · On-site
$35.71 - $43.31/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
$35.71 - $40.43/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
$35.71 - $40.43/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Rhinebeck, NY · On-site
$32.96 - $37.48/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Rhinebeck, NY · On-site
$32.96 - $37.48/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
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.
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.
Utilization Manager
Rhinebeck, NY · On-site
$32.96 - $37.48/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Rhinebeck, NY · On-site
$32.96 - $37.48/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
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 ...
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 ...
Utilization Manager
$35.71 - $40.43/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
$35.71 - $40.43/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Rhinebeck, NY · On-site
$32.96 - $37.48/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 ...
Utilization Manager
Rhinebeck, NY · On-site
$32.96 - $37.48/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 ...
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.
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.
Utilization Manager
$35.71 - $43.31/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 ...
Utilization Manager
$35.71 - $43.31/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 ...
Utilization Manager
Ellenville, NY · On-site
$35.71 - $40.43/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Ellenville, NY · On-site
$35.71 - $40.43/hr
Participates in the agency's Quality Improvement / Utilization Management Committee. * Provides ... i.e., standards review and conformance auditing. * Performs other duties as assigned.
Utilization Manager
Ellenville, NY · On-site
$35.71 - $40.43/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 ...
Utilization Manager
Ellenville, NY · On-site
$35.71 - $40.43/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 ...
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
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 ...
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 ...
Utilization Management Auditor information
See salary details
$15.63 - $19.08
14% of jobs
$21.93 is the 25th percentile. Wages below this are outliers.
$19.08 - $22.53
14% of jobs
$22.53 - $25.98
17% of jobs
The median wage is $27.88 / hr.
$25.98 - $29.44
11% of jobs
$29.44 - $32.89
8% of jobs
$32.89 - $36.34
6% of jobs
$38.93 is the 75th percentile. Wages above this are outliers.
$36.34 - $39.79
7% of jobs
$39.79 - $43.25
7% of jobs
$43.25 - $46.70
5% of jobs
$46.70 - $50.15
5% of jobs
$50.15 - $53.61
5% of jobs
$15
$31
$53
How much do utilization management auditor jobs pay per hour?
As of May 28, 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 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.
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 is a healthcare professional responsible for reviewing medical records, claims, and utilization data to ensure that healthcare services provided to patients are necessary, appropriate, and comply with established guidelines and policies. They help identify overuse, underuse, or misuse of medical resources and ensure regulatory compliance. Utilization Management Auditors work closely with healthcare providers, insurance companies, and regulatory agencies to improve the quality and cost-effectiveness of patient care.
What is the difference between Utilization Management Auditor vs Utilization Review Nurse?
| Aspect | Utilization Management Auditor | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license, certifications like CCM or CUC | Licensed Registered Nurse (RN), often with additional certifications |
| Work Environment | Office-based, insurance companies, healthcare organizations | Hospital, clinics, insurance companies, often in clinical settings |
| Primary Focus | Auditing and reviewing utilization data for compliance and cost management | Assessing 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.
More about Utilization Management Auditor jobs
What cities are hiring for Utilization Management Auditor jobs? Cities with the most Utilization Management Auditor job openings:
What states have the most Utilization Management Auditor jobs? States with the most job openings for Utilization Management Auditor jobs include:
What job categories do people searching Utilization Management Auditor jobs look for? The top searched job categories for Utilization Management Auditor jobs are:
- Assistant Remote Utilization Review
- Director Remote Utilization Review
- Remote Dental Utilization Management
- Temporary Medical Utilization Review Physician
- Concurrent Review
- Commission Optum Utilization Review
- Utilization Management Clinical Analyst
- Medical Director Utilization Management
- Milliman Care Guidelines
- Remote Supervisor Utilization Management
Full-time
Medical, Retirement
Posted 10 days ago
Job description
Registered Nurse
Looking for Utilization Management AND Education experience.
Scope of work:
In conjunction with Medical Management leadership, coordinates the educational plan for the Behavioral Health, Care Management, and Utilization Management departments. Stakeholders include staff, physicians, department leadership, and third-party vendors. Uses specific age and culture-related physical, intellectual, psychological, and development attributes in the educational plans for staff. Reports to either a Director of Behavioral Health, Care Management, or Utilization Management with matrix reporting to other areas in Medical Management.
- Develops/implements the educational plan for Behavioral Health, Care Management, and Utilization Management.
Develops/implements orientation of new staff which is comprehensive and individualized with one-on-one training for three or more weeks.
Rounding and telephonic support of staff education needs and problem solving.
Ongoing education based on analysis of outcomes from external audits.
Education and support for implementation and ongoing use of new electronic medical record system and supplemental ancillary computer systems.
Collaborate with educators to Provide education and support as needed. - Conducts department-specific assessment for educational needs related to Compliance Monitoring and Education.
Monthly auditing of Compliance Risk areas and identification of staff education and documentation needs to ensure compliance
Annual education on InterQual criteria changes with annual Interrater Reliability Assessment.
Analyze and evaluate the effectiveness of all educational activities. - Conducts educational workshops to medical management and related audiences as requested.
Education of changes and payor requirements to targeted Physician groups. - Develops informational materials and/or other media to be distributed to internal/external customers.
Internal/external orientation material.
Maintains and updates repositories of educational content needed for staff orientation, day-to-day operations, and continuing education on Sharepoint sites.
Develops annual education plan to ensure Care and Utilization management staff have access to current best practice and relevant updates.
Monthly auditing for specific areas of focus as directed by leadership, to ensure adherence to clinical best practice. - Department Liaison for external audits.
Coordinates and facilitates with other departments to ensure readiness for audits
Analyze audit recommendations
Reporting outcomes and development/implementation of staff education as needed.
Assists with project and program improvement efforts
Qualifications
- Required Bachelor's Degree
- Preferred Master's Degree
- Utilization Management experience highly preferred.
- Education and/or training experience highly preferred
- 3 years of relevant experience Must have 3 to 5 years' experience in Care Management, or Utilization Management. Required
- Registered Nurse (RN) - State of Michigan Upon Hire required
How Corewell Health cares for you
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Priority Health - 1231 E Beltline Ave NE - Grand RapidsDepartment Name
Utilization Management - PH Managed BenefitsEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8 a.m. to 5 p.m.Days Worked
Monday to FridayWeekend Frequency
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