Nursing experience with at least 2 years in Utilization Management or case management role Preferred: 2 years * Leadership or management experience in nursing or related field Core Competencies ...
Nursing experience with at least 2 years in Utilization Management or case management role Preferred: 2 years * Leadership or management experience in nursing or related field Core Competencies ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Working knowledge of URAC and NCQA. * 2+ years' experience in a UM team within managed care setting ...
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The Utilization Management Nurse performs medical necessity and benefit review requests in ... Working knowledge of URAC and NCQA. * 2+ years' experience in a UM team within managed care setting ...
Utilization Management Nurse
Des Moines, IA · On-site
$40/hr
Utilization Management Nurse We are seeking a dedicated Utilization Management Nurse to provide ... The role includes a 2-3 week training period with a buddy system for support. The team is friendly ...
Utilization Management Nurse
Des Moines, IA · On-site
$40/hr
Utilization Management Nurse We are seeking a dedicated Utilization Management Nurse to provide ... The role includes a 2-3 week training period with a buddy system for support. The team is friendly ...
Commits to the mission, vision, beliefs and consistently demonstrates our core values. 2. ... Assists with Utilization Management functions by participating in concurrent and retrospective ...
Commits to the mission, vision, beliefs and consistently demonstrates our core values. 2. ... Assists with Utilization Management functions by participating in concurrent and retrospective ...
Commits to the mission, vision, beliefs and consistently demonstrates our core values. 2. ... Assists with Utilization Management functions by participating in concurrent and retrospective ...
Commits to the mission, vision, beliefs and consistently demonstrates our core values. 2. ... Assists with Utilization Management functions by participating in concurrent and retrospective ...
Minimum 2 years of managed care or HMO experience (Medicare Advantage experience required ). * Core Expertise: Must have direct experience in: * Concurrent Review & Inpatient Utilization Management
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Minimum 2 years of managed care or HMO experience (Medicare Advantage experience required ). * Core Expertise: Must have direct experience in: * Concurrent Review & Inpatient Utilization Management
Utilization Management Nurse
Chapel Hill, NC · On-site +1
... 2+ years' experience in a UM team within managed care setting. • 3+ years' experience in clinical nurse setting preferred. • TPA Experience preferred.
Utilization Management Nurse
Chapel Hill, NC · On-site +1
... 2+ years' experience in a UM team within managed care setting. • 3+ years' experience in clinical nurse setting preferred. • TPA Experience preferred.
Utilization Management - RN
Sunnyvale, CA · On-site
Minimum 2 years of managed care or HMO experience. * Experience performing medical necessity reviews using evidence-based clinical guidelines. * Strong knowledge of: Concurrent Review, Utilization ...
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Utilization Management - RN
Sunnyvale, CA · On-site
Minimum 2 years of managed care or HMO experience. * Experience performing medical necessity reviews using evidence-based clinical guidelines. * Strong knowledge of: Concurrent Review, Utilization ...
Utilization Management - RN
Sunnyvale, CA · On-site
Minimum 2 years of managed care or HMO experience. * Experience performing medical necessity reviews using evidence-based clinical guidelines. * Strong knowledge of: Concurrent Review, Utilization ...
Utilization Management - RN
Sunnyvale, CA · On-site
Minimum 2 years of managed care or HMO experience. * Experience performing medical necessity reviews using evidence-based clinical guidelines. * Strong knowledge of: Concurrent Review, Utilization ...
Minimum 2 years of managed care or HMO experience (Medicare Advantage experience required ). * Core Expertise: Must have direct experience in: * Concurrent Review & Inpatient Utilization Management
Minimum 2 years of managed care or HMO experience (Medicare Advantage experience required ). * Core Expertise: Must have direct experience in: * Concurrent Review & Inpatient Utilization Management
Commits to the mission, vision, beliefs and consistently demonstrates our core values. 2. ... Assists with Utilization Management functions by participating in concurrent and retrospective ...
Commits to the mission, vision, beliefs and consistently demonstrates our core values. 2. ... Assists with Utilization Management functions by participating in concurrent and retrospective ...
Utilization Management Coordinator
Glen Burnie, MD · On-site
$386K/yr
Knowledge, Skills and Abilities 1. Knowledge of utilization management is preferred. 2. Highly effective verbal and written skills are required. 3. Strong communication skills, self-confidence and ...
Utilization Management Coordinator
Glen Burnie, MD · On-site
$386K/yr
Knowledge, Skills and Abilities 1. Knowledge of utilization management is preferred. 2. Highly effective verbal and written skills are required. 3. Strong communication skills, self-confidence and ...
Utilization Management - RN
Sunnyvale, CA · On-site
Minimum 2 years of managed care or HMO experience. * Experience performing medical necessity reviews using evidence-based clinical guidelines. * Strong knowledge of: Concurrent Review, Utilization ...
Utilization Management - RN
Sunnyvale, CA · On-site
Minimum 2 years of managed care or HMO experience. * Experience performing medical necessity reviews using evidence-based clinical guidelines. * Strong knowledge of: Concurrent Review, Utilization ...
Utilization Management Supervisor (PPM III)
Seattle, WA · On-site
$110K - $139K/yr
Two years recent supervisory experience in mental health setting, preferably mental health residential treatment, Utilization Management or Quality Assurance. * Two years of recent demonstrated ...
Utilization Management Supervisor (PPM III)
Seattle, WA · On-site
$110K - $139K/yr
Two years recent supervisory experience in mental health setting, preferably mental health residential treatment, Utilization Management or Quality Assurance. * Two years of recent demonstrated ...
RN - Utilization Management
Franklin, NH · On-site
Minimum 2-3 years of acute care hospital nursing experience required. * Prior experience in Utilization Management, Case Management, or Care Coordination preferred. * Strong knowledge of InterQual ...
RN - Utilization Management
Franklin, NH · On-site
Minimum 2-3 years of acute care hospital nursing experience required. * Prior experience in Utilization Management, Case Management, or Care Coordination preferred. * Strong knowledge of InterQual ...
... utilization management excellence. RN Utilization Lead under the general supervision of the ... Re gistered nurse (RN) with current Florida license with a minimum of two (2) years experience ...
... utilization management excellence. RN Utilization Lead under the general supervision of the ... Re gistered nurse (RN) with current Florida license with a minimum of two (2) years experience ...
Knowledge, Skills and Abilities 1. Knowledge of utilization management is preferred. 2. Highly effective verbal and written skills are required. 3. Strong communication skills, self-confidence and ...
Knowledge, Skills and Abilities 1. Knowledge of utilization management is preferred. 2. Highly effective verbal and written skills are required. 3. Strong communication skills, self-confidence and ...
... utilization management excellence. RN Utilization Lead under the general supervision of the ... Re gistered nurse (RN) with current Florida license with a minimum of two (2) years experience ...
... utilization management excellence. RN Utilization Lead under the general supervision of the ... Re gistered nurse (RN) with current Florida license with a minimum of two (2) years experience ...
Utilization Management Nurse
Los Angeles, CA · On-site
$60 - $75/hr
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files ... Expectations: 1. Completes orientation according to expected standards. 2. Works with close ...
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Utilization Management Nurse
Los Angeles, CA · On-site
$60 - $75/hr
As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files ... Expectations: 1. Completes orientation according to expected standards. 2. Works with close ...
Active RN or LPN license (RN preferred) -- Maryland compact/eligibility required * 5+ years clinical nursing experience * 2+ years care management / utilization management experience * MCG experience ...
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Active RN or LPN license (RN preferred) -- Maryland compact/eligibility required * 5+ years clinical nursing experience * 2+ years care management / utilization management experience * MCG experience ...
Utilization Management Ii information
See salary details
$39K - $50.3K
15% of jobs
$50.3K - $61.5K
8% of jobs
$63.2K is the 25th percentile. Wages below this are outliers.
$61.5K - $72.8K
15% of jobs
The median wage is $79.9K / yr.
$72.8K - $84.1K
20% of jobs
$84.1K - $95.4K
11% of jobs
$101K is the 75th percentile. Wages above this are outliers.
$95.4K - $106.6K
13% of jobs
$106.6K - $117.9K
5% of jobs
$117.9K - $129.2K
3% of jobs
$129.2K - $140.5K
4% of jobs
$140.5K - $151.7K
3% of jobs
$151.7K - $163K
3% of jobs
$39K
$89.5K
$163K
How much do utilization management ii jobs pay per year?
As of Sep 6, 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 a Utilization Management II?
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 a Utilization Management II 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.
What is the difference between Utilization Management Ii vs Utilization Management Specialist?
| Aspect | Utilization Management Ii | Utilization Management Specialist |
|---|---|---|
| Credentials | Typically requires a healthcare-related certification (e.g., RN, CPC) | Often requires similar healthcare certifications or experience |
| Work Environment | Healthcare insurance companies, hospitals, or managed care organizations | Insurance companies, healthcare providers, or case management teams |
| Employer & Industry Usage | Commonly used in health insurance and managed care settings | Used 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.
More about Utilization Management Ii jobs
What job categories do people searching Utilization Management Ii jobs look for?
The top searched job categories for Utilization Management Ii jobs are:
- Remote Chiropractic Utilization Review
- Full Time Weekend Utilization Review
- Director Of Utilization Review
- International Utilization Review Rn
- Remote Dental Utilization Management
- Rn Utilization Review Nurse
- Temporary Medical Utilization Review Physician
- Remote Utilization Review
- Remote Bcba Utilization Review
- Medical Utilization Review Physician
Utilization Management Manager-Utilization Mgmt- Days - FT
Gulfport, MS • On-site
Full-time
Re-posted 28 days ago
Job description
Oversee the management of patient care utilization, ensuring appropriate healthcare services are provided while optimizing resource use. This individual will be responsible for leading a team of nurses who review medical necessity, appropriateness and efficiency of healthcare services. Ensure compliance with regulatory requirements and maintain high standards of care.
Education Requirements
Required: Bachelor Degree
- Bachelor of Science in Nursing, with an active unrestricted license
Preferred: Master's Degree
- Nursing or other clinical discipline, Health Administration, Finance, Business Administration, or a related field
License or Certification Requirements
Required: License
- Nursing degree (RN, BS, BSN, or advanced degree) and unrestricted active nursing license
Experience Requirements
Required: 5 years
- Nursing experience with at least 2 years in Utilization Management or case management role
Preferred: 2 years
- Leadership or management experience in nursing or related field
Core Competencies
Knowledge:
- In depth knowledge of healthcare utilization management processes, medical terminology and clinical guidelines
- Familiarity with payer requirements and regulation including Medicare, Medicaid and private insurers
- Working knowledge of applications that are used to enhance utilization management based on evidenced based approach and guidelines
- Strong knowledge of Microsoft Office applications
Skills:
- Analytical Skills: The ability to analyze large data sets, determine trends, synthesize results, and deliver prioritized details through effective reporting
- Communication Skills: Strong communication and interpersonal skills for effective collaboration and education
- Problem-Solving Skills: The capacity to understand issues, derive many potential solutions, troubleshoot discrepancies, and understand systematic approaches to problem resolution
Abilities:
- Attention to Detail: Precision is essential when reporting critical analysis to inform decision-making and operational change
- Time Management: Managing multiple tasks and deadlines while prioritizing work is essential in a fast-paced healthcare environment
- Technology Proficiency: Beyond EHR systems, familiarity with various billing software and technology tools
Work Environment: This position may involve working in a variety of clinical and administrative settings, requiring adaptability and a proactive approach to problem-solving.
Physical Demands: Frequent reaching, sitting, walking, and standing may be required. No special coordination beyond that used for normal mobility and handling of everyday objects and materials is needed to perform the job.
- Supervise and lead the UM nursing team and Pre-Certification Specialists, ensuring the review of patient cases for appropriate medical necessity and care protocols
- Develop, implement and maintain UM policies and procedures in accordance with healthcare regulation and organizational standards
- Conduct regular training and provide ongoing support for UR team to improve knowledge and performance
- Collaborate with physicians, other healthcare providers and insurance companies to review and improve treatment plans. Ensure all services are medically necessary and cost effective
- Evaluate and analyze healthcare utilization trends, identify opportunities for improvement and solutions to improve outcome
- Monitor and ensure compliance with regulatory requirements including Medicare, Medicaid and other payer policies
- Prepare and present reports on utilization metrics, case reviews and outcomes to administration leadership groups
- Resolve complex case issues and provide guidance on challenging utilization decisions
- Ensure accurate documentation of all UM reviews, ensuring compliance with internal and external audit
- Foster effective communication between departments, stakeholders and healthcare professionals