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Utilization Management Clinical Analyst Jobs (NOW HIRING)

Global Alliant Inc

Clinical Analyst

Baltimore, MD · On-site

Job Title: Clinical Analyst Job Location: Remote Job Duration: Contract / FTE Client: Federal ... Utilization Management / Utilization Review / Prior Authorization * Clinical or healthcare ...

UMR

Utilization Management & Clinical Validation RN

$60K - $107K/yr

  • Retirement

Utilization Management & Clinical Validation Rn Optum is a global organization that delivers care ... analysis of chart indicates opportunities. The Appeals nurse will perform their job functions ...

P3 Health Partners

Manager Utilization Management

Omaha, NE · On-site

$100K - $140K/yr

In this leadership role, you'll guide a team of UM professionals, collaborate with key clinical and ... What You'll Do As the Utilization Management Manager, you'll provide leadership, oversight, and ...

New

P3 Health Partners

Manager Utilization Management

Tucson, AZ · On-site

$100K - $140K/yr

In this leadership role, you'll guide a team of UM professionals, collaborate with key clinical and ... What You'll Do As the Utilization Management Manager, you'll provide leadership, oversight, and ...

New

Ampcus

Spec, Utilization Management

Baltimore, MD · On-site

Spec, Utilization Management Job Location: Baltimore, MD Utilizing key principles of utilization ... analyze clinical information, contracts, mandates, medical policy, evidence-based published ...

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Utilization Management Clinical Analyst information

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$62

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

As of Aug 14, 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?

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

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Cities with the most Utilization Management Clinical Analyst job openings:

What states have the most Utilization Management Clinical Analyst jobs?

States with the most job openings for Utilization Management Clinical Analyst jobs include:

What job categories do people searching Utilization Management Clinical Analyst jobs look for?

The top searched job categories for Utilization Management Clinical Analyst jobs are:

Utilization Management Clinical Analyst jobs near you
Infographic showing various Utilization Management Clinical Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $82,791 per year, or $39.8 per hour.

Clinical Analyst

Global Alliant Inc

Baltimore, MD • On-site

Contractor

Posted 10 days ago

Job description

Job Title: Clinical Analyst
Job Location: Remote
Job Duration: Contract / FTE
Client: Federal
Criteria- Need US citizenship because of federal regulations and the sensitive nature of the work involved.
Ability to obtain Public Trust Clearance
Must-have skills
  • US Healthcare / US Payer / Provider experience
  • Utilization Management / Utilization Review / Prior Authorization
  • Clinical or healthcare educational background
  • ICD-10, CPT, HCPCS
  • Claims, denials, billing or medical-necessity review
  • Provider communication / provider calls
  • Healthcare policy research and interpretation
  • Case investigation / issue resolution
  • Excel and reporting
  • SOP/process documentation
  • Strong written and verbal communication
  • Able to work 8 AM-6 PM EST coverage
Global Alliant logo

About Global Alliant

Sourced by ZipRecruiter

Global Alliant is an Innovative and Award winning Information Technology and Software Development Company based in Maryland. We partner with clients to transform their complex and mission critical business challenges using Digital Transformation, Cloud Modernization, Agile Engineering, and Process Automation Solutions. Our core capabilities reach across Public Sectors composed of Federal, State, and Local Government Agencies, and deliver the Best in Class Solutions. Global Alliant understands rapid policy changes to bring suitable program and delivery oversight coupled with technical subject matter expertise to not only meet but exceed client expectations.

Industry

It services

Company size

51 - 200 Employees

Headquarters location

Columbia, MD, US

Year founded

2016

Social media

Twitter

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