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Utilization Management Physician information

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$39K

$91K

$167.5K

How much do utilization management physician jobs pay per year?

As of Jun 27, 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 are the key skills and qualifications needed to thrive as a Utilization Management Physician, and why are they important?

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.

What are Utilization Management Physicians?

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.
More about Utilization Management Physician jobs
What cities are hiring for Utilization Management Physician jobs? Cities with the most Utilization Management Physician job openings:
What states have the most Utilization Management Physician jobs? States with the most job openings for Utilization Management Physician jobs include:
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 June 2026, with employment types broken down into 3% Internship, 53% Full Time, 8% Part Time, 8% Temporary, 25% Contract, and 3% Nights. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $91,011 per year, or $43.8 per hour.
Utilization Management - Medical Director

Utilization Management - Medical Director

Atlas Search

New York, NY

$200K - $225K/yr

Full-time

Posted 9 days ago

Job description

New York Metro Area (Candidates Must Reside in NY, NJ, or CT)

Full-Time | Hybrid Leadership Opportunity

Total Compensation Range: $200k - $225k

We are seeking an experienced Medical Director of Utilization Management to provide clinical leadership within a growing health plan environment serving Medicare and Medicaid populations.

This is an outstanding opportunity for a physician who enjoys collaborating across multidisciplinary teams, driving quality outcomes, ensuring regulatory compliance, and helping members receive the right care at the right time.

What You'll Do

  • Serve as the physician leader and clinical resource for Utilization Management operations.
  • Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations.
  • Partner with executive leadership to develop and execute medical management initiatives.
  • Monitor utilization trends and identify opportunities to improve quality, efficiency, and cost-effectiveness.
  • Participate in interdisciplinary care planning discussions to support coordinated member care.
  • Ensure compliance with federal, state, accreditation, and contractual requirements.
  • Support organizational readiness for audits, surveys, regulatory reviews, and investigations.
  • Utilize care management platforms to document clinical reviews and decision-making activities.
  • Evaluate utilization data and performance metrics to support strategic planning efforts.
  • Contribute to annual departmental goals and provide ongoing progress updates.
  • Maintain current knowledge of evolving Medicare, Medicaid, and managed care regulations.
  • Collaborate with quality, care management, pharmacy, and operational teams to improve health outcomes.

Required

  • Medical Doctor (MD or DO) degree, licensed in NY.
  • Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or related specialty.
  • 3+ years of experience in health plan medical management.
  • Experience supporting Medicare and Medicaid products, including managed care populations.
  • Background in utilization management across inpatient and outpatient settings.
  • Experience performing appeals reviews and medical necessity determinations.
  • Strong knowledge of New York healthcare market dynamics.

What Makes You Successful

  • Strategic thinker with strong clinical judgment.
  • Excellent communicator who can build relationships across departments.
  • Data-driven leader focused on quality improvement and member outcomes.
  • Strong understanding of healthcare regulations and managed care operations.
  • Passion for improving access, affordability, and quality of care.

SEO Keywords

Medical Director, Utilization Management, Physician Executive, Medical Management, Managed Care, Medicare, Medicaid, MLTC, MAP, MAPD, D-SNP, Appeals Review, Peer-to-Peer Review, Population Health, Value-Based Care, Health Plan Leadership, New York Physician Jobs


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Atlas Search is a tri-state area recruitment agency, connecting new graduates, Advanced Practice Providers, Physicians and Nurse Leaders to hospitals, clinics, multi-specialty groups, nursing homes, managed care companies, private practices, and healthcare start-ups.

If you would like to learn more about the opportunities we offer, please submit your CV for consideration here.

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