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Utilization Management Physician Jobs (NOW HIRING)

LCMC Health

Collaborate with the Physician Advisor Team to both reduce denials and identify areas for clinical ... Certification in Case Management and/or Utilization Management preferred. WORK SHIFT: Days (United ...

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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.
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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 Manager-Utilization Mgmt- Days - FT

Utilization Management Manager-Utilization Mgmt- Days - FT

Memorial Health System

Gulfport, MS

Full-time

Posted 17 days ago

Job description

Oversee the management of patient care utilization, ensuring appropriate healthcare services are provided while optimizing resource use. This individual will be responsible for leading a team of nurses who review medical necessity, appropriateness and efficiency of healthcare services.  Ensure compliance with regulatory requirements and maintain high standards of care. 

Education Requirements

Required:  Bachelor Degree

  • Bachelor of Science in Nursing, with an active unrestricted license

Preferred:  Master's Degree

  • Nursing or other clinical discipline, Health Administration, Finance, Business Administration, or a related field

License or Certification Requirements

Required:  License

  • Nursing degree (RN, BS, BSN, or advanced degree) and unrestricted active nursing license

Experience Requirements

Required:  5 years 

  • Nursing experience with at least 2 years in Utilization Management or case management role

Preferred:  2 years

  • Leadership or management experience in nursing or related field

Core Competencies

Knowledge:

  • In depth knowledge of healthcare utilization management processes, medical terminology  and clinical guidelines
  • Familiarity with payer requirements and regulation including Medicare, Medicaid and private insurers
  • Working knowledge of applications that are used to enhance utilization management based on evidenced based approach and guidelines
  • Strong knowledge of Microsoft Office applications

Skills:

  •  Analytical Skills:  The ability to analyze large data sets, determine trends, synthesize results, and deliver prioritized details through effective reporting
  • Communication Skills:  Strong communication and interpersonal skills for effective collaboration and education
  • Problem-Solving Skills:  The capacity to understand issues, derive many potential solutions, troubleshoot discrepancies, and understand systematic approaches to problem resolution

Abilities:

  • Attention to Detail:  Precision is essential when reporting critical analysis to inform decision-making and operational change
  • Time Management:  Managing multiple tasks and deadlines while prioritizing work is essential in a fast-paced healthcare environment
  • Technology Proficiency: Beyond EHR systems, familiarity with various billing software and technology tools

Work Environment:  This position may involve working in a variety of clinical and administrative settings, requiring adaptability and a proactive approach to problem-solving.

Physical Demands:  Frequent reaching, sitting, walking, and standing may be required. No special coordination beyond that used for normal mobility and handling of everyday objects and materials is needed to perform the job.

  • Supervise and lead the UM nursing team and Pre-Certification Specialists, ensuring the review of patient cases for appropriate medical necessity and care protocols
  • Develop, implement and maintain UM policies and procedures in accordance with healthcare regulation and organizational standards
  • Conduct regular training and provide ongoing support for UR team to improve knowledge and performance
  • Collaborate with physicians, other healthcare providers and insurance companies to review and improve treatment plans.  Ensure all services are medically necessary and cost effective
  • Evaluate and analyze healthcare utilization trends, identify opportunities for improvement and solutions to improve outcome
  • Monitor and ensure compliance with regulatory requirements including Medicare, Medicaid and other payer policies
  • Prepare and present reports on utilization metrics, case reviews and outcomes to administration leadership groups
  • Resolve complex case issues and provide guidance on challenging utilization decisions
  • Ensure accurate documentation of all UM reviews, ensuring compliance with internal and external audit
  • Foster effective communication between departments, stakeholders and healthcare professionals

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