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Utilization Management Clinical Assistant Jobs (NOW HIRING)

Sky Mavis

Manager Utilization Management

Henderson, NV · On-site

$100K - $140K/yr

In this leadership role, you'll guide a team of UM professionals, collaborate with key clinical and ... * Assist with preparation for and participation in audits conducted by health plans, NCQA, CMS ...

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 ... * Assist with preparation for and participation in audits conducted by health plans, NCQA, CMS ...

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 ... * Assist with preparation for and participation in audits conducted by health plans, NCQA, CMS ...

Sky Mavis

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 ... * Assist with preparation for and participation in audits conducted by health plans, NCQA, CMS ...

P3 Health Partners, Inc.

$100K - $140K/yr

In this leadership role, you'll guide a team of UM professionals, collaborate with key clinical and ... * Assist with preparation for and participation in audits conducted by health plans, NCQA, CMS ...

Oakland Community Health Network

$56K - $70K/yr

This position applies clinical expertise and evidence-based criteria to support timely utilization management decisions, promote appropriate resource utilization, and ensures quality, person-centered ...

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Utilization Management Clinical Assistant information

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

As of Sep 13, 2026, the average hourly pay for utilization management clinical assistant in the United States is $20.23, according to ZipRecruiter salary data. Most workers in this role earn between $16.59 and $23.32 per hour, depending on experience, location, and employer.

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Infographic showing various Utilization Management Clinical Assistant job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $42,079 per year, or $20.2 per hour.

MANAGER OF UTILIZATION REVIEW

Mayfield Heights, OH

Southwest General
Hospitals • 1 - 5K employees
Learn more about Southwest Generalexternal

Full-time

Posted 11 days ago

Southwest General Health Center rating

6.9

Company rating: 6.9 out of 10

Based on 46 frontline employees who took The Breakroom Quiz

Job description

Summary

  • POSITION INFORMATION
    • Position summary:
      • The Utilization Management (UM) RN Manager is responsible for the day-to-day leadership, operational oversight, and performance management of the Utilization Management nursing team. Reporting to the UM RN Director, the Manager translates department strategy, regulatory and payer requirements, approved clinical review criteria, and organizational priorities into consistent daily execution.
      • The role provides direct supervision, coaching, workflow management, clinical-operational support, and performance oversight for assigned UM staff. The Manager collaborates with physician advisors/medical directors, case management, clinical operations, revenue cycle, payer relations, quality, compliance, and other stakeholders to support timely, accurate, evidence-informed utilization management decisions and appropriate stewardship of healthcare resources.
  • MINIMUM QUALIFICATIONS
    • Education:
      • Bachelor of Science in Nursing (BSN) required, or equivalent qualification consistent with organizational policy.
      • Masters degree in Nursing, Healthcare Administration, Business Administration, Public Health, or a related field preferred.

    • Required length and type of experience:
      • Five or more years of progressive clinical nursing and/or utilization management experience preferred, including three or more years of experience in utilization management, utilization review, case management, managed care, or a closely related function.
      • Prior formal leadership experience required; two or more years of supervisory or management experience preferred.

    • Required licensure, certification or registry:
      • Current Ohio State Board of Nursing license required.
      • Certified Case Manager (CCM) certification preferred.
      • Accredited Case Manager (ACM) certification preferred.
    • Core Knowledge, Skills, and Competencies
      • Knowledge of utilization management and utilization review principles, including prospective, concurrent, and retrospective review.
      • Knowledge of medical necessity, patient status, level-of-care review, authorization processes, payer requirements, denial prevention, and escalation pathways.
      • Knowledge of evidence-based clinical review criteria and appropriate use of clinical decision-support tools.
      • Knowledge of regulatory and accreditation requirements affecting utilization management and clinical review.
      • Demonstrated ability in people leadership, coaching, performance management, conflict resolution, and change management.
      • Demonstrated ability to interpret operational analytics and KPIs, conduct root-cause analysis, and drive process improvement.
      • Demonstrated ability to communicate effectively across interdisciplinary teams, including nursing, physicians, physician advisors, payers, revenue cycle, and leadership.
      • Demonstrated application of professional nursing judgment, ethical practice, confidentiality, and appropriate stewardship of healthcare resources.

What Southwest General Health Center employees say

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