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Utilization Management Auditor Jobs (NOW HIRING)

Molina Healthcare

Auditor, Clinical Services

Tampa, FL

$29.05 - $56.64/hr

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 ...

Molina Healthcare

Auditor, Clinical Services

Tampa, FL · On-site

$29.05 - $56.64/hr

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 ...

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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 23, 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.
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:
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.
Utilization and Care Management Nurse

Utilization and Care Management Nurse

Cambia Health Solutions

Lewiston, ID • On-site

$34.20 - $55.70/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 15 days ago

Cambia Health Solutions rating

8.4

Company rating: 8.4 out of 10

Based on 31 frontline employees who took The Breakroom Quiz

102nd of 261 rated insurance

Job description

Utilization and Care Management Nurse
Work from home within Oregon, Washington, Idaho or Utah
Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated team of Nurses are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Utilization and Care Management Nurses provide utilization and care management (such as prospective concurrent, retrospective review, post-discharge care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services - all in service of making our members' health journeys easier.
Are you a Nurse who has a passion for healthcare? Are you a Nurse who is ready to take your career to the next level and make a real difference in the lives of our members? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
  • Associate or Bachelor's Degree in Nursing or related field
  • 3 years of case management, utilization management, disease management, auditing or retrospective review experience
  • Equivalent combination of education and experience
  • Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care.
  • May need to have licensure in all four states served by Cambia: Idaho, Oregon, Utah, Washington.
  • Must have at least one of the following: Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Masters' degree in Behavioral Health preferred for behavioral health); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management)

Skills and Attributes:
  • Knowledge of health insurance industry trends, technology and contractual arrangements.
  • General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.
  • Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
  • Strong verbal, written and interpersonal communication and customer service skills.
  • Ability to interpret policies and procedures and communicate complex topics effectively.
  • Strong organizational and time management skills with the ability to manage workload independently.
  • Ability to think critically and make decisions within individual role and responsibility.

What You Will Do at Cambia:
  • Conducts utilization management reviews (prospective, concurrent, and retrospective) to ensure medical necessity and compliance with policy and standards of care.
  • Participate in care management to identify and coordinate health care needs and gaps for members during the period of discharge from a facility until 30 days post discharge.
  • Applies clinical expertise and evidence-based criteria to make determinations and consults with physician advisors as needed.
  • Collaborates with interdisciplinary teams, case management, and other departments to facilitate transitions of care and resolve issues.
  • Serves as a resource to internal and external customers, providing accurate and timely responses to inquiries.
  • Identifies opportunities for improvement and participates in quality improvement efforts.
  • Maintains accurate and consistent documentation and prioritizes assignments to meet performance standards and corporate goals.
  • Protects confidentiality of sensitive documents and issues while communicating professionally with members, providers, and regulatory organizations.

#LI-Remote
Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.
  • Oregon, Washington, Utah, and Idaho: The expected hiring range is
    $36.80 - $49.80 an hour and the full salary range is $34.20 - $55.70 an hour.

  • The bonus target for this position is 10%.

About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
  • Work alongside diverse teams building cutting-edge solutions to transform health care.
  • Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
  • Grow your career with a company committed to helping you succeed.
  • Give back to your community by participating in Cambia-supported outreach programs.
  • Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
  • Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
  • Annual employer contribution to a health savings account.
  • Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
  • Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
  • Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
  • Award-winning wellness programs that reward you for participation.
  • Employee Assistance Fund for those in need.
  • Commute and parking benefits.

Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

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