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Utilization Management Clinical Analyst Jobs (NOW HIRING)

Peak Health

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 ...

Intus, Inc

Utilization Management Nurse

$80K - $95K/yr

Blending clinical expertise with analytical thinking, the Utilization Management Nurse ensures services are medically necessary, aligned with care plans and consistent with PACE regulations and best ...

LCMC Health

Working collaboratively with clinical, operational, and revenue cycle leadership, this position ... Analyze system-level data including but not limited to LOS, readmissions, avoidable days, denial ...

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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 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:
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 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.
Senior Director Clinical Quality and Policy

Senior Director Clinical Quality and Policy

Delta Dental Ins.

Rancho Cordova, CA • On-site

$85K - $116K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 19 days ago

Job description

JOB DESCRIPTION
The Senior Director of Clinical Quality & Policy provides enterprise clinical leadership for a transforming dental health plan, ensuring that clinical policy, quality strategy, and utilization management are grounded in evidence-based care, data-driven decision-making, and whole-person health outcomes.
This leader will be accountable for key clinical functions including Utilization Management, Clinical Review, and Clinical Quality, while also helping shape the organization's broader clinical positioning in the marketplace and supporting the development of integrated care models that connect oral health to whole person health. The Senior Director brings strong clinical credibility, policy expertise, business acumen, and strategic leadership to help influence enterprise priorities, provider engagement, quality outcomes, and market differentiation.
This leader moves confidently between strategy and execution while bringing the credibility to engage with providers and clinical leaders, the business acumen to influence enterprise decisions, and the vision to help position the organization more broadly in the marketplace as a trusted health plan focused on quality, whole person care, and improved outcomes
This role operates as a peer executive leader and consensus builder across clinical, operational, and enterprise stakeholders.
RESPONSIBILITIES
  • Provide strategic and operational oversight for Utilization Management, Clinical Review, and Clinical Quality functions.
  • Influence provider strategy by helping translate clinical standards, policy expectations, and quality priorities into clear guidance and engagement approaches.
  • Help shape the organization's clinical positioning in the marketplace by contributing to thought leadership, external credibility, provider engagement, and strategic partnerships.
  • Ensures the policies that orients company and providers to delivery patient health through policy design, policy execution and policy compliance.
    Develop and govern dental clinical protocols, standards of care, and evidence-based guidelines. Ensure clinical policies reflect best practices, emerging science, and oral-systemic health principles. Chair or co-chair clinical policy governance forums and guide consensus-based clinical decision-making. Translate clinical policy into clear clinical intent that informs utilization management and quality programs.
  • Enables continuous Clinical Quality Improvement - Advance Quality & Outcomes. Provide quality leadership focused on outcomes, effectiveness, variation reduction, and continuous improvement. Oversee clinical quality programs that monitor member outcomes, safety, and care appropriateness. Use data and analytics to identify opportunities to improve clinical performance, care efficiency, and member experience.
    Operate as a consensus builder who brings stakeholders together around shared clinical and quality objectives.
  • Drive Strategy, Innovation & Transformation Help shape the organization's clinical positioning in the marketplace by contributing to thought leadership, external credibility, provider engagement, and strategic partnerships. Align dental clinical strategy with broader business goals, including growth, innovation, and integrated care. Contribute to initiatives focused on medical-dental integration, oral-systemic health, and whole-person care.
  • Lead and develop teams across clinical policy, dental directors, utilization management clinical staff, and clinical quality oversight. Serve as a trusted clinical voice for internal stakeholders and external partners. Represents Delta Dental of California and affiliated companies when working with industry representatives

    • QUALIFICATIONS
    Minimum Qualifications
    • 12+ years w/Bachelor's degree; 3+ years management

    Additional Experience
    • DDS or DMD required
    • Active, unrestricted dental license, or ability to obtain appropriate licensure if required
    • Minimum of 10 years of transformational leadership experience in dental, managed care, health plan, payer, or related healthcare environments
    • Significant experience in clinical quality, utilization management, clinical review, and clinical policy
    • Demonstrated experience in both direct clinical care and administrative leadership
    • Experience applying evidence-based practice, clinical research, or scientific literature to clinical policy, quality, or care model decisions
    • Proven ability to influence senior leaders and work effectively across a complex, matrixed organization
    • Strong strategic thinking and ability to translate clinical expertise into business and operational impact
    • Senior-level leadership experience in clinical quality, clinical policy, utilization management, or related roles within a health plan, healthcare organization, or integrated care environment.
    • Strong executive presence with the ability to influence, build consensus, and lead through change.

    Knowledge, Skills, Abilities
    • Advanced knowledge of managed care principles
    • Verbal and written communication skills
    • Dental background and knowledge of dental managed care
    • Strong Organizational and retention skills
    • Must gave strong attention to detail and ability to handle multiple concurrent tasks with constant interruptions
    • Successful presentation and negotiation skills
    • Ability to maintain confidentiality
    • Ability to coordinate activities over large service areas
    • Demonstrated capability to interface & maintain effective relationships with all levels of management and business partners
    • Demonstrated analytical & problem solving skills and experience at both a strategic and functional level

    Base Pay Information
    The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity.
    Pay Grade 27. $190,254.00 - $439,724.00
    ADDITIONAL INFORMATION
    Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes:
    • Competitive base and incentive pay
    • 401(k) with robust matching and non-matching contributions
    • Rich medical & pharmacy benefits
    • 100% employer-paid dental and vision benefits
    • Holistic wellbeing program with deep financial incentives
    • Generous paid time off plus 12 paid holidays and your birthday off
    • Culture of growth and learning: career development; tuition reimbursement; recognition program
    • Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
    • Social responsibility and volunteer opportunities
    • Employee discount program

    Fair Chance Ordinances and Criminal Background Considerations
    This position requires that the applicant undergo a background check. Qualified applicants with arrest or conviction records will be considered for employment in accordance with any applicable federal, state or local laws, including, but not limited to, the California Fair Chance Act, the Los Angeles County Fair Chance Ordinance, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, and/or New York Corrections Law Article 23-A.
    #LI-Hybrid
    ABOUT THE TEAM
    At Delta Dental, we're behind millions of smiles and counting. For over 68 years, we've served our communities by increasing access to affordable, quality care - but that commitment to care extends beyond the people we serve, to the dedicated employees who make those smiles genuine. We've come this far by building fair programs that offer opportunities for advancement, create meaningful connections and improve the lives of our employees and their families. Because we know that when we take exceptional care of each other, we can make a positive impact for all.
    We champion an inspirational workplace through our commitment to trust, service, excellence and innovation. Joining us means working for a company that offers stability and balance, opportunities for leadership at all levels, and a work environment focused on teamwork and camaraderie.
    Discover the smiling faces behind Delta Dental and experience our values and culture in action by connecting with us on social media. Follow Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn. If you've got an appetite for innovation and want to be a part of a team that's transforming the future of health care, join us!
    Since 1955, we have offered comprehensive, high-quality oral health care benefits to millions of enrollees and built the strongest network of dental providers in the country. The Delta Dental of California network includes affiliates Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; and Delta Dental of West Virginia, providing dental benefits to more than 31 million people across 15 states, the District of Columbia, Puerto Rico and the Virgin Islands.
    The company and its affiliates are part of Delta Dental Plans Association (DDPA), a not-for-profit national association based in Oak Brook, Illinois. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. We offer vision coverage through DeltaVision in 15 states and the District of Columbia. Collectively, we deliver benefits to more Americans than any other dental insurance company.
    Delta Dental Ins. is an equal opportunity employer and is committed to providing a professional work environment free from discrimination and harassment. Individuals seeking employment at Delta Dental are considered without regard to race, ethnicity, color, age, sex, religion, national origin, ancestry, pregnancy, sexual orientation, gender identity, gender expression, genetic information, actual or perceived physical or mental disability, registered domestic partner status, caregiver status, marital status, veteran or military status, citizenship status, or any other legally protected category. Delta Dental is committed to providing equal employment opportunities to all employees and applicants for employment. Accordingly, we have adopted and maintain an Equal Employment Opportunity Policy, Harassment-Free Work Environment Policy, and Respectful Workplace policies and will not tolerate violations of these policies.
    Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico, District of Columbia (Washington D.C.) or other US Territories at this time.
    Proof of eligibility to work in the United States must be provided if selected for hire.
    *Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York
    If You Are A Current Employee Click Here To Apply

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