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Utilization Management Clinical Analyst Jobs (NOW HIRING)

Bryan Health

Utilization Management Manager

Lincoln, NE · On-site

... analytics and technology solutions to streamline operational efficiencies. 6. *Serves as the ... Reports periodically at various Clinical Committee meetings. 25. Maintains professional growth and ...

WVU Medicine

Clinical Utilization Management Pharmacist

$121K - $144K/yr

... analysis of claims data to assess effectiveness of current formulary and utilization management strategies. 12. Serve as a clinical pharmacy preceptor for residents and rotational pharmacy students ...

Bryan Health

Utilization Management Manager

Lincoln, NE · On-site

... analytics and technology solutions to streamline operational efficiencies. 6. *Serves as the ... Reports periodically at various Clinical Committee meetings. 25. Maintains professional growth and ...

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Utilization Management Clinical Analyst information

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$39

$62

How much do utilization management clinical analyst jobs pay per hour?

As of Jul 24, 2026, the average hourly pay for utilization management clinical analyst in the United States is $39.80, according to ZipRecruiter salary data. Most workers in this role earn between $31.49 and $45.67 per hour, depending on experience, location, and employer.

How does a Utilization Management Clinical Analyst typically collaborate with clinical and administrative teams to ensure optimal patient care?

A Utilization Management Clinical Analyst works closely with both clinical staff, such as nurses and physicians, and administrative teams to review patient cases and ensure that treatments and services are medically necessary and align with payer guidelines. This role often involves participating in interdisciplinary meetings, communicating findings and recommendations, and helping to develop or refine care protocols. Effective collaboration is essential to balance quality patient care with cost efficiency, and analysts regularly provide feedback and support to improve clinical workflows and documentation.

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

To thrive as a Utilization Management Clinical Analyst, you need a solid background in healthcare, strong analytical abilities, and credentials such as RN or LPN licensure or relevant clinical certifications. Familiarity with utilization management software, electronic health records (EHRs), and claims processing systems is typically required. Excellent communication, critical thinking, and attention to detail are soft skills that help you collaborate effectively and make sound clinical determinations. These competencies are crucial for ensuring the appropriate use of medical resources, maximizing patient outcomes, and maintaining regulatory compliance.

What does a Utilization Management Clinical Analyst do?

A Utilization Management Clinical Analyst reviews and analyzes medical records, claims, and treatment plans to ensure that healthcare services provided to patients are medically necessary and cost-effective. They work with healthcare providers, insurance companies, and patients to evaluate the appropriateness of medical care based on established guidelines and policies. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulatory standards.

What is the difference between Utilization Management Clinical Analyst vs Utilization Review Nurse?

AspectUtilization Management Clinical AnalystUtilization Review Nurse
CredentialsHealthcare degree, certifications like CCM or CUCRegistered Nurse (RN), state licensure, certifications like CCM
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, insurance companies, outpatient facilities
Employer & IndustryHealth insurance providers, managed care organizationsHospitals, insurance companies, healthcare facilities
Common Search & ComparisonUtilization Management Clinical Analyst vs Utilization Review Nurse

The main difference between a Utilization Management Clinical Analyst and a Utilization Review Nurse lies in their focus and credentials. Clinical Analysts often have healthcare degrees and certifications like CCM, working primarily in insurance or managed care settings. Utilization Review Nurses are registered nurses with licensure, working in hospitals or outpatient facilities. Both roles involve reviewing medical necessity, but their work environments and professional backgrounds differ.

More about Utilization Management Clinical Analyst jobs
What cities are hiring for Utilization Management Clinical Analyst jobs? Cities with the most Utilization Management Clinical Analyst job openings:
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Utilization Management Clinical Analyst jobs near you
Infographic showing various Utilization Management Clinical Analyst job openings in the United States as of July 2026, with employment types broken down into 1% Locum Tenens, 65% Full Time, 4% Part Time, and 30% Contract. Highlights an 61% Physical, 5% Hybrid, and 34% Remote job distribution, with an average salary of $82,791 per year, or $39.8 per hour.
Clinical Nursing Analyst - Harrisburg

Clinical Nursing Analyst - Harrisburg

Senior LIFE

Steelton, PA

Full-time

Posted 2 days ago

Job description

PACE Consulting Solutions is currently seeking a Clinical Analyst for a full time role that will cover our Harrisburg and York locations. 

The Clinical Analyst performs medical record audit/validation processes to ensure that documentation rendered is complete, compliant, and accurate. Candidates must be well versed in all policies, procedures, best practices, and regulatory requirements. This position will provide real time feedback to management, clinical and non-clinical staff, and contracted providers to ensure compliance with all regulatory requirements.

Requirements

  • RN license is preferred
  • Minimum of 3 years experience in health care management and regulatory oversight
  • Valid PA driver’s license

Responsibilities

  • Review documentation to assure compliance with all Medicare, Medicaid, and federal regulations
  • Identify areas of improvement, write plans of correction, and provide staff education
  • Provide on-site support during regulatory audits.
  • Build trusting relationships with Senior LIFE program staff through open communication and education
  • Monitor development and implementation of all quality initiatives to ensure they are data driven, have measurable goals, and are aimed at maintaining or improving care based on outcome measures.
  • Provide site visits to include real time auditing of center activities and member care
  • Provide oversight of real time auditing completed by program staff to ensure compliance
  • Schedule, facilitate and participate in mock audits of programs to gauge audit readiness and to identify areas for improvement. Provide mock audit reports and oversee remediation process

EOE



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