ZipRecruiter

Log In

1

Utilization Management Ii Jobs (NOW HIRING)

Oak St. Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

Active, unrestricted RN license in your state of residence. * 2+ years of RN experience in an adult ... Managed Care and/or Utilization Management experience. * Candidates located in the Eastern Time ...

Humana

Utilization Management Nurse

Become a part of our caring community The Part C Grievance & Appeals (G&A) Nurse (Utilization Management Nurse 2) utilizes clinical nursing skills to support the coordination, documentation and ...

previous page

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 Sep 7, 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, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

Utilization Management - RN

Bickham Services Unlimited, LLC

Sunnyvale, CA • On-site

Contractor

Re-posted 14 days ago

Job description

Title: Utilization Management - RN

Start Date: 08/10/2026

End Date: 02/10/2027

# of Openings: 1

Position Type: Contract

Locations: Long Beach, CA

Additional Details:

-This is a 6-month contract position with a possibility of an extension

-Must have experience with Medicare Advantage.

-Must have experience with Concurrent Review, Inpatient, Utilization Management, Discharge Planning, and Transitions of Care


Description:

Our client is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical necessity reviews, discharge planning, and transitions of care while collaborating with physicians, hospitals, and interdisciplinary teams to ensure members receive appropriate, cost-effective, and evidence-based care. This position is ideal for an RN with strong acute care experience and a background in managed care, utilization management, or case management.

What You Will Do:

  • Perform concurrent, prior authorization, and retrospective utilization reviews.
  • Evaluate medical necessity using InterQual, MCG, CMS, LCD/NCD, and health plan guidelines.
  • Coordinate discharge planning and transitions of care with providers and healthcare facilities.
  • Collaborate with physicians, hospital staff, specialists, and internal care management teams.
  • Request and review additional clinical documentation when necessary.
  • Escalate complex medical necessity cases to the Medical Director.
  • Educate providers on utilization management policies and review criteria.
  • Document all reviews and clinical decisions accurately within medical management systems.
  • Identify care gaps and support quality improvement initiatives.
  • Serve as a clinical resource for internal teams.

You Will Be Successful If:

  • You have strong clinical judgment and are confident making medical necessity determinations.
  • You can effectively communicate with physicians, hospitals, and multidisciplinary teams.
  • You are highly organized and able to manage multiple cases simultaneously.
  • You thrive in a fast-paced managed care environment.
  • You are comfortable navigating challenging conversations regarding levels of care.
  • You are detail-oriented and committed to delivering high-quality patient outcomes.

What You Will Bring:

  • Active Registered Nurse (RN) license with the ability to obtain licensure in multiple states.
  • Graduate of an accredited School of Nursing.
  • Minimum 4 years of clinical nursing experience.
  • 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 Management, Discharge Planning, Transitions of Care
  • Experience applying: InterQual, MCG, CMS Guidelines
  • Experience working with medical management software and Microsoft Office.
  • Excellent communication, critical thinking, and organizational skills.

Preferred Experience

  • Bachelor of Science in Nursing (BSN).
  • Emergency Department (ER) experience.
  • Intensive Care Unit (ICU) experience.
  • Case Management experience.
  • Utilization Management experience within a health plan or managed care organization.
  • Experience working directly with hospitals, physicians, and provider networks.