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Utilization Management Physician Jobs (NOW HIRING)

St. Cloud Orthopedics

$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 ...

Actalent

Utilization Management Nurse

Des Moines, IA · On-site

$40/hr

Utilization Management Nurse We are seeking a dedicated Utilization Management Nurse to provide ... Engage with Medical Directors and Physician Reviewers for services not meeting medical criteria.

Intus, Inc

Utilization Management Manager

The role partners closely with the IntusCare Utilization Management clients, the IntusCare Director of Clinical Operations and the Contracted Physician to assure high quality service and customer ...

UHS

Director Utilization Management

Plymouth, IN

Responsibilities Director Utilization Management Michiana Behavioral Health (a UHS facility ... a physician network and various related services located in 40 U.S. states, Washington, D.C ...

New

UHS

Director Utilization Management

Plymouth, IN

Responsibilities Director Utilization Management Michiana Behavioral Health (a UHS facility ... a physician network and various related services located in 40 U.S. states, Washington, D.C ...

New

Collab Capital

$98 - $132/hr

The role partners closely with the IntusCare Utilization Management clients, the IntusCare Director of Clinical Operations and the Contracted Physician to assure high quality service and customer ...

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

Collaborates with attending physician if ambiguous documentation pertaining to patient status placement requires clarification. Utilizes electronic utilization management database for documentation ...

MUSC

Utilization Management Nurse-1

Murrells Inlet, SC · On-site

Summary MUSC Community Physicians (MCP) is an entity within the Medical University of South ... One year of case management and/or utilization management work experience preferred. Staff hired ...

Medical University of South Carolina

Summary MUSC Community Physicians (MCP) is an entity within the Medical University of South ... One year of case management and/or utilization management work experience preferred. Staff hired ...

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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 Sep 4, 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.

Medical Director, Utilization Management Physician - Optum - Remote

St. Cloud Orthopedics

On-site

$249 - $373/hr

Other

Medical, Retirement

Posted 5 days ago

Key responsibilities

  • Supports WellMed Medical Management by making utilization management determinations and identifying utilization trends.

  • Participates in case review, medical necessity determination, and development of medical management protocols.

  • Oversees physician compliance with utilization management plans and provides education on medical technologies, review criteria, and policies.

Job description

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 is changing the way clinicians work and live.

The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over or under utilization of services and proactively suggesting improvements to WellMed Medical Management's utilization management program.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Position Highlights & Primary Responsibilities:
  • Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values
  • Remain current and proficient in CMS criteria hierarchy and organizational determination processes
  • Participates in case review and medical necessity determination
  • Maintain proficiency in compliance regulations for both CMS and delegated health plans
  • Conducts post service reviews issued for medical necessity and benefits determination coding
  • Assists in development of medical management, care management, and utilization management protocols
  • Performs all other related duties as assigned
Customer Service:
  • Oversees and ensures physician compliance with UM plan
  • Performs all duties in a professional and responsible manner
  • Responds to physicians and staff in a prompt, pleasant and professional manner
  • Respects physician, patient, and organizational confidentiality
  • Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met
  • Personal and Physician Development
  • Strives to personally expand working knowledge of all aspects of the UM department
  • An active participant in physician meetings
  • Orients new physicians to ensure understanding of company policy and resources available for physician support
  • Assists in the growth and development of subordinates by sharing special knowledge with others and promotes continued education classes
  • Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S.
  • Board certification in Family Medicine, Internal Medicine, or emergency medicine
  • An active, unrestricted medical license (any state)
  • 5+ years of post-residency clinic practice experience
  • Proficiency with Microsoft Office applications
Preferred Qualifications:
  • 2+ years of experience in utilization management activities
  • 2+ years of experience with acute admissions
  • 2+ years of experience working in a managed care health plan environment
  • Bilingual (English/Spanish) fluency

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $248,500.00 to $373,000.00 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline:

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.

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