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Utilization Management Ii Jobs (NOW HIRING)

Corewell Health

Utilization Mgmt Spec

Southfield, MI · Hybrid

... degree. * 2 years of relevant experience healthcare experience. About Corewell Health As a team ... Name Utilization Management - Diversified East WB Mkt Employment Type Full time Shift Day (United ...

Welbehealth

Utilization Management RN

Los Angeles, CA

$99K - $131K/yr

By guiding this team, the Utilization Management RN Supervisor drives the continuous improvement of ... Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team ...

WelbeHealth

Utilization Management RN

Los Angeles, CA

$99K - $131K/yr

By guiding this team, the Utilization Management RN Supervisor drives the continuous improvement of ... Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team ...

WelbeHealth

Utilization Management RN

Los Angeles, CA · On-site

$99K - $131K/yr

By guiding this team, the Utilization Management RN Supervisor drives the continuous improvement of ... Two (2) years of supervisory experience with demonstrated aptitude to mentor and develop team ...

Genesis HealthCare

Utilization Management Overview of Position: Acts as part of a multidisciplinary team including ... reimbursement certification. 2. Applies approved utilization acuity criteria to monitor ...

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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.
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:
Utilization Management Ii jobs near you
UTILIZATION MANAGEMENT COORDINATOR II MSO

UTILIZATION MANAGEMENT COORDINATOR II MSO

North East Medical Services

Burlingame, CA • On-site

$39.69 - $45.10/hr

Other

Medical, Dental, Vision, Retirement

Posted 3 days ago

Job description

The Utilization Management Coordinator II functions under the direct supervision of a physician or Registered Nurse performing utilization management (UM) and care coordination duties for the NEMS MSO. The UM Coordinator II will also provide basic training to the junior UM Coordinators.
ESSENTIAL JOB FUNCTIONS:
  • Responsible to review Referral Requests and Treatment Authorization Requests received daily; process and approve authorization requests according to the NEMS MSO Authorization Grid and established clinical guidelines.
  • Provide guidance to junior UM Coordinators during research of additional clinical guidelines from different sources for complex cases.
  • Responsible to lead the junior UM Coordinators to prepare and present complex cases to Medical Director for review and ensure follow up activities.
  • Responsible for reviewing the confirmed MD approval/modification/denial decision and notes for record tracking purposes.
  • Responsible to prepare UM Notice of Action (NOA) to provider and member for UM denial decision per AB1455 turn-around-time requirement.
  • Responsible for preparing UM statistical reports and submit to health plans per contract requirement.
  • Perform Care Coordination activities with members, families, specialists, and ancillary providers for authorized services.
  • Perform case investigation for member and/or provider complaints and appeals related to UM denials, and report findings to Health Plan.
  • Provide transition of care services to members who are discharged from the hospital.
  • Perform customer services for UM inquires to PCP, specialist, and members.
  • Stay current with DHCS regulations, Health Plan agreements, and Industry Standard guidelines applicable to healthcare programs.
  • Communicate with Health Plan for clarification about clinical guidelines for covered/uncovered benefits.
  • Communicate UM related information and updates to all members of the health care team, patients, and their families.
  • Follows the appropriate turnaround timeframe for decisions and notification of members and providers.
  • Performs other job duties as required by manager/supervisor.

QUALIFICATIONS:
  • BS/BA Degree in Health Science or General Education highly preferred.
  • Minimum of one year of experience in utilization management required.
  • Recent experience in a clinic or outpatient setting desirable; able to perform efficiently and appropriately in a busy environment.
  • Current Medical Assistant Certification or California Pharmacy Technician License or equivalent experience in a health care field is a plus.
  • Knowledge of medical terminology is a must
  • Strong communication, analytical, and problem-solving skills.
  • Knowledge of community resources and cultural needs.
  • Good organization and prioritization skills, outstanding in time management.

LANGUAGE:
  • Must be able to fluently speak, read and write English.
  • Fluent in Chinese (Cantonese and/or Mandarin) preferred.
  • Fluent in other languages is an asset.

STATUS:
  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This is a full-time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

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