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Utilization Management Ii Jobs (NOW HIRING)

VEST MONROE LLC

Utilization Management Coordinator

Monroe, GA · On-site

$25 - $28/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

A minimum of two (2) years' experience in a healthcare setting or managed care company, with experience in patient assessment, treatment planning, utilization management, and/or case management. Your ...

LCMC Health

... 2. Regulatory & Compliance Oversight * Ensure compliance with federal, state, and payer ... Certification in Case Management and/or Utilization Management preferred. WORK SHIFT: Days (United ...

Oak St. Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Required Qualifications 2+ years of experience as a Registered Nurse in adult acute care/critical ... residence Utilization Management is a 24/7 operation and work schedules will include weekends ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

System One

Utilization Management Specialist

Baltimore, MD · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

Luminis Health

Utilization Management Nurse

Annapolis, MD

$34 - $55/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... EPIC 2. Denial Management : Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up ...

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Showing results 41-60

All JobsUtilization Management Ii Jobs

Utilization Management Ii information

See salary details

$39K

$89.5K

$163K

How much do utilization management ii jobs pay per year?

As of Aug 16, 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?

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.

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
Infographic showing various Utilization Management Ii job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

Director - Utilization Management, Physical Health

Jobtailor

Morrisville, NC • On-site

$110 - $150/hr

Other

Posted 10 days ago

Job description

Responsibilities
  • Administer and coordinate physical health utilization management activities
  • Ensure the UM Department operates as an integrated department
  • Oversee the correct level and intensity of services for individuals
  • Manage and develop staff to maintain a qualified workforce
  • Collaborate with the Director of Behavioral Health Utilization Management
Requirements
  • Bachelors in Nursing with 7 years' post-degree experience
  • At least 2 years of supervisory experience
  • At least 2 years Utilization Management experience or substantially equivalent experience
  • Master's degree in Nursing and 5 years' experience including 2 years of supervisory experience and UM experience or equivalent experience
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