ZipRecruiter

Log In

1

Utilization Management Physician Jobs (NOW HIRING)

Colorado PA

$249 - $373/hr

WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that ...

previous pagenext page

Showing results 21-40

All JobsUtilization Management Physician Jobs

Utilization Management Physician information

See salary details

$39K

$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.

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 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.

Director, Utilization Management

Alameda Health System

Oakland, CA • On-site

Full-time

Medical, Retirement, PTO

Re-posted 21 hours ago

Alameda Health System rating

8.3

Company rating: 8.3 out of 10

Based on 16 frontline employees who took The Breakroom Quiz

Job description

  • 100% employer health plan for employees and their eligible dependents
  • Unique benefit offerings that are partially or 100% employer-paid
  • Rich and varied retirement plans and the ability to participate in multiple plans.
  • Generous paid time off plans

Role Overview:

Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic planning, compliance, and collaboration. Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician collaboration, and aligns with organizational objectives while adapting to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: Following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification. 

  • Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. 
  • Monitor and evaluate the utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures. 
  • Analyze data and generate reports on utilization trends, outcomes and quality indicators to support decision-making and process improvement initiatives. Reports to appropriate committees. 
  • Manage quality of performance criteria, policies and procedures, and service standards for the utilization management operations. Evaluate utilization reviews and determine program improvements.  
  • Develop and implement utilization review policies and procedures in accordance with industry standards and regulatory requirements.  
  • Direct and coordinate data gathering and record keeping legally required by federal and state agencies, the Joint Commission, and hospital policies; participates in the risk mitigation, process of implementing new or revised processes, and projects 
  • Foster effective communication and collaboration with internal departments, external agencies, and insurance providers to facilitate the utilization review process. 
  • Participate in interdisciplinary committees and meetings to contribute to the development and implementation of quality improvement initiatives.  
  • Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals. Maintains minimal denial rates by Medicare, MediCal, private and contracted payers through appropriate direction of utilization practices; assists physicians and hospital personnel in understanding UM matters. 
  • Perform all other duties as assigned. 
  • Prepares cost analysis reports and other data needed for the preparation of the departmental budget. 
  • Provides in-house educational programs as needed for both staff and physicians. 
  • Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of UM and administrative staff. 
  • Serves as a content expert to staff and internal departments and external partners; networks with other hospitals, nursing organizations, and professional organizations to keep abreast of changes within the profession.

MINIMUM QUALIFICATIONS:

Required Education: Bachelor’s degree in Nursing

Preferred Education: Master’s degree in Nursing 

Required Experience: Three years of utilization review experience. Health insurance company and/or acute care hospital, post-acute and psych; three years of InterQual and/or MCG. Strong clinical nursing background.

Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.

Preferred Licenses/Certifications: UM / CM certifications

What Alameda Health System employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply