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Utilization Management Physician information

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$91K

$167.5K

How much do utilization management physician jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization management physician in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 per year, depending on experience, location, and employer.

What is a utilization management physician?

Utilization Management Physicians are medical doctors who review healthcare services and treatments to ensure they are medically necessary and appropriate according to established guidelines. They work with insurance companies, hospitals, and healthcare providers to evaluate requests for procedures, medications, and hospital admissions. Their primary goal is to promote effective, efficient, and evidence-based care while controlling healthcare costs. Utilization Management Physicians do not usually provide direct patient care but instead use their clinical expertise to assess medical records and treatment plans. Their decisions can help prevent unnecessary treatments and optimize patient outcomes.

What are the key skills and qualifications needed to thrive as a utilization management physician?

To thrive as a Utilization Management Physician, you need a valid medical degree, board certification, and strong clinical experience in a relevant medical specialty. Familiarity with utilization review tools, medical necessity criteria (such as MCG or InterQual), and electronic health record (EHR) systems is typically required. Excellent analytical thinking, communication, and negotiation skills help in making fair determinations and collaborating with healthcare providers. These skills are crucial to ensure appropriate, cost-effective care while maintaining compliance with healthcare regulations and quality standards.

What are some common challenges a utilization management physician might face when reviewing cases?

Utilization Management Physicians frequently encounter the challenge of balancing cost-effective care with ensuring patients receive appropriate, high-quality medical services. They often need to make complex decisions with incomplete information and must stay current on clinical guidelines and payer policies. Additionally, they collaborate closely with providers and case managers, sometimes navigating difficult conversations regarding coverage denials or alternative treatment recommendations. Effective communication and strong clinical judgement are essential for success in this role.

What is the difference between Utilization Management Physician vs Utilization Review Nurse?

AspectUtilization Management PhysicianUtilization Review Nurse
CredentialsMedical degree, medical license, board certification in relevant specialtyNursing degree, RN license, certification in case management or utilization review
Work EnvironmentHospitals, insurance companies, healthcare management organizationsHospitals, insurance companies, outpatient clinics
Primary ResponsibilitiesReview medical necessity, approve or deny services, develop treatment plansAssess medical records, coordinate care, support decision-making

Utilization Management Physicians and Utilization Review Nurses both play vital roles in healthcare utilization review. Physicians focus on medical necessity and treatment approval, while nurses handle record assessments and care coordination. Both roles require healthcare credentials and work in similar environments, but their responsibilities differ based on medical expertise and scope of practice.

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Cities with the most Utilization Management Physician job openings:

What states have the most Utilization Management Physician jobs?

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What job categories do people searching Utilization Management Physician jobs look for?

The top searched job categories for Utilization Management Physician jobs are:

Utilization Management Physician jobs near you
Infographic showing various Utilization Management Physician job openings in the United States as of August 2026, with employment types broken down into 87% Full Time, and 13% Contract. Highlights an 62% In-person, and 38% Remote job distribution, with an average salary of $91,011 per year, or $43.8 per hour.

Utilization Management Physician (UMP) - Remote - Florida

ProTouch Staffing

Daytona Beach, FL • On-site

Other

Medical, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Utilization Management Physician (UMP) - Remote

Full-Time | 40 Hours Weekly

A leading healthcare organization is seeking an experienced Utilization Management Physician (UMP) for a full-time remote opportunity. This role is ideal for a physician with strong clinical judgment, managed care experience, and expertise in medical necessity review and evidence-based decision-making.

The position is primarily remote, with occasional on-site attendance required for meetings and committee participation in Daytona Beach, Florida.

Position Highlights

  • Remote full-time role

  • 40 hours per week

  • Bonus opportunity

  • Must be available via phone, email, and Microsoft Teams

  • On-site presence required periodically for meetings/committees

    • Location: Daytona Beach, FL

Key Responsibilities

  • Review and render determinations for:

    • Pre-authorization requests

    • Initial and concurrent clinical reviews

    • Post-service decisions, including claims and appeals

  • Apply medical necessity criteria using nationally recognized guidelines, including:

    • MCG (Milliman Care Guidelines)

    • InterQual

    • CMS (Medicare/Medicaid) standards

    • Internal protocols and coverage documents

  • Participate in annual review and updates of clinical criteria and scripts

  • Provide physician support and guidance to Utilization Management staff

  • Conduct peer-to-peer discussions with treating providers (phone or electronic)

  • Assist with provider education regarding treatment protocols and best practices

  • Participate in medical and utilization management committees as requested

Patient/Plan Focus

This role supports utilization review across multiple plan types, including:

  • Medicare

  • Medicaid

  • Commercial health plans

Requirements

  • MD or DO from an accredited medical school

  • Active, unrestricted Florida medical license

  • Board certification in primary specialty preferred

  • Minimum 3 years' experience as a Utilization Management Physician

  • 3-7 years of overall clinical experience

  • Knowledge of managed care health plan operations and benefits

  • Strong working knowledge of medical policy application and evidence-based criteria

  • Willingness to participate in audit/interrater reliability processes to ensure consistency


Compensation & Benefits


  • Annual bonus opportunity

  • 401(k) retirement plan

  • Health benefits for provider and eligible dependents

  • Malpractice insurance provided

  • Paid leave time

  • CME stipend

  • Licenses, fees, and dues reimbursement

  • Travel reimbursement

Location

Remote (Florida)
Occasional on-site meetings in Daytona Beach, FL

Protouch Staffing logo

About Protouch Staffing

Sourced by ZipRecruiter

Protouch Staffing, based in Plano, Texas, is a leading provider in the healthcare staffing industry. Established over 30 years ago, the company prides itself on delivering quality services in the fields of nursing, allied health, pharmaceuticals, healthcare IT, and more. Committed to building lasting relationships, Protouch Staffing continually exceeds client expectations by providing unparalleled service, superior patient care, and talented healthcare professionals.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Frisco, TX, US

Year founded

1989

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