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Utilization Management Ii Jobs (NOW HIRING)

WelbeHealth

Utilization Management RN

Los Angeles, CA · On-site

$99K - $131K/yr

Utilization Management RN Los Angeles, CA, USA At WelbeHealth, we are transforming the reality of ... Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team ...

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Utilization Management Ii information

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$39K

$89.5K

$163K

How much do utilization management ii jobs pay per year?

As of Jun 8, 2026, the average yearly pay for utilization management ii in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Management Ii vs Utilization Management Specialist?

AspectUtilization Management IiUtilization Management Specialist
CredentialsTypically requires a healthcare-related certification (e.g., RN, CPC)Often requires similar healthcare certifications or experience
Work EnvironmentHealthcare insurance companies, hospitals, or managed care organizationsInsurance companies, healthcare providers, or case management teams
Employer & Industry UsageCommonly used in health insurance and managed care settingsUsed across insurance, healthcare, and case management sectors

Utilization Management Ii and Utilization Management Specialist roles share similar credentials and work environments, often within healthcare insurance or managed care organizations. The main difference lies in the level of responsibility, with the Utilization Management Ii typically handling more complex cases or reviews, while the Specialist may focus on routine assessments.

What is a Utilization Management II role?

A Utilization Management II (UM II) professional is responsible for reviewing and evaluating the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. This role typically involves working with healthcare providers, insurance companies, and patients to ensure that care provided aligns with established guidelines and policies. UM II professionals may conduct case reviews, process authorization requests, and help prevent unnecessary medical costs. They often have clinical backgrounds and use their expertise to make informed decisions about patient care. The 'II' designation usually indicates intermediate experience or responsibility level, often requiring prior experience in utilization management or a related field.

How does the Utilization Management II role typically collaborate with healthcare providers and internal teams to make care decisions?

In a Utilization Management II position, you will frequently interact with healthcare providers to review clinical documentation and determine the medical necessity of proposed treatments or services. Collaboration with internal teams such as case managers, medical directors, and claims specialists is also essential to ensure care decisions align with organizational policies and regulatory guidelines. This role often involves participating in interdisciplinary meetings, discussing complex cases, and providing feedback to improve processes. Strong communication and negotiation skills are key, as you'll serve as a liaison between providers, members, and the health plan.

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

To thrive as a Utilization Management II, you need a strong background in healthcare management, clinical review, and knowledge of medical terminology, often supported by a nursing or healthcare degree and relevant licensure. Familiarity with utilization review software, electronic health records (EHRs), and industry-standard coding systems like ICD-10 and CPT is typically required. Strong analytical thinking, communication, and negotiation skills help professionals collaborate effectively with providers and payers. These competencies are vital for ensuring appropriate care utilization, regulatory compliance, and cost management within healthcare organizations.
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What job categories do people searching Utilization Management Ii jobs look for? The top searched job categories for Utilization Management Ii jobs are:
Utilization Management Ii jobs near you
Utilization Management RN

Utilization Management RN

WelbeHealth

Los Angeles, CA

Other

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

WelbeHealth rating

5.8

Company rating: 5.8 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

Job description

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, functioning as both a care provider and care plan to those individuals we serve.

Our Health Plan Services team plays a critical role in our participant's journey and our Utilization Management team ensures we can provide timely, quality, compliant, and cost-effective care to our participants. By guiding this team, the Utilization Management RN Supervisor drives the continuous improvement of our care delivery processes.

Essential Job Duties:

  • Direct oversight of day-to-day operations within the designated UM team
  • Assist the team in reviewing prior-authorization requests for medical necessity and appropriateness
  • Identify, develop, and provide orientation and competency development for staff processing and/or reviewing authorizations
  • Collaborate with providers (internal and external), clinical staff, and others to timely resolve any utilization management issues

Job Requirements:

  • Minimum of three (3) years of relevant clinical nursing experience
  • Strong preference for prior PACE experience
  • Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team members

Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

  • Medical insurance coverage (Medical, Dental, Vision)
  • Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and sick time
  • 401K savings + match
  • Advancement opportunities - we've got a track record of hiring and promoting from within, meaning you can create your own path!
  • And additional benefits
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About WelbeHealth

Sourced by ZipRecruiter

WelbeHealth is a healthcare organization based in Menlo Park, CA, US. Specializing in the field of healthcare and wellness, the company focuses its services primarily on senior citizens. They operate in a model known as Program of All-inclusive Care for the Elderly (PACE), which aims to provide complete health care services for seniors. The company was founded with the belief in the capacity of every human being for wellness, dignity, and joy.

Industry

Health care and social assistance

Company size

501 - 1,000 Employees

Headquarters location

Menlo Park, CA, US

Year founded

2016

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