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Utilization Management Physician Jobs (NOW HIRING)

Dignity Health Management Services

$57.37 - $85.33/hr

... physician review based on medical necessity. Every day you will partner with both the Pre-Service and In-Patient Utilization Management teams. You will ensure to monitor and assure the ...

NHC

Utilization Management Manager

Knoxville, TN · On-site

We are currently seeking a dedicated and detail-oriented Utilization Management (UM) Manager to ... Work with physicians, therapist and nursing staff to provide optimal review based on patient needs.

New

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 ...

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 Aug 12, 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?

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 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.
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What cities are hiring for Utilization Management Physician jobs? Cities with the most Utilization Management Physician job openings:
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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 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $91,011 per year, or $43.8 per hour.

Physician Advisor Clin Res Mgm / Clinical Resource Management

Hartford HealthCare at Home

Wethersfield, CT • On-site

Other

Posted 4 days ago

Job description

Clinical Resource Management Physician Advisor (Full-Time)
At Hartford HealthCare in Connecticut
Every day, more than 40,000 Hartford HealthCare colleagues come to work united by one shared purpose: knowing every moment matters. As Connecticut's most comprehensive, physician-led healthcare network, we are transforming the delivery of care through innovation, collaboration, education, and excellence.
We invite you to join a nationally recognized health system where physicians are empowered to lead, collaborate, and make a meaningful impact on patient care across the continuum.
About Hartford HealthCare
Hartford HealthCare is one of the nation's most integrated healthcare systems, serving patients at more than 500 locations across Connecticut, including eight acute care hospitals, a large multispecialty physician group, behavioral health services, rehabilitation, home care, senior services, and an extensive network of ambulatory sites.
The Clinical Resource Management team plays a vital role in ensuring patients receive the right care, at the right time, in the most appropriate setting while maintaining exceptional clinical outcomes and regulatory excellence.
Position Summary
Hartford HealthCare is seeking a Clinical Resource Management Physician Advisor to join our collaborative system-wide team. Reporting to the Associate Medical Director of Clinical Resource Management, the Physician Advisor partners closely with Clinical Resource Management nurses, physician colleagues, hospital leadership, and payer organizations to promote appropriate utilization of healthcare resources while supporting high-quality, patient-centered care.
This physician leader serves as a clinical resource for utilization management, level of care determinations, regulatory compliance, and physician education. The ideal candidate combines strong clinical judgment with excellent communication and collaboration skills to help optimize patient outcomes, improve operational efficiency, and support fiscal stewardship across the health system.
Primary Responsibilities
  • Provide second-level physician review for level of care determinations and appropriate utilization of healthcare resources.
  • Collaborate with Clinical Resource Management nurses to ensure patients receive care in the most clinically appropriate setting.
  • Communicate directly with attending physicians regarding level of care determinations, documentation opportunities, and resource utilization.
  • Conduct peer-to-peer discussions with payer medical directors to support authorization requests, appeals, and denial management.
  • Maintain expertise in CMS regulations, commercial payer guidelines, utilization management standards, and regulatory requirements.
  • Educate physicians and clinical teams on utilization management best practices, documentation, and evolving regulatory standards.
  • Participate in quality improvement initiatives that enhance patient care, operational performance, and regulatory compliance.
  • Meet established Physician Advisor coverage expectations and participate in additional projects as assigned.
Qualifications
Education
  • Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
Experience
  • Minimum 5 years of acute care clinical experience required (Hospital based)
  • 3 years or more of prior physician advisor experience or utilization management/managed care experience required.
Licensure
  • Unrestricted Connecticut medical license (or eligibility to obtain one).
Knowledge, Skills & Abilities
The successful candidate will demonstrate:
  • Strong clinical judgment and decision-making skills.
  • Excellent communication, collaboration, and relationship-building abilities.
  • Ability to educate and effectively communicate with physician and APP colleagues and to guide appropriate documentation and level of care decisions. Ability to also communicate effectively with payor organizations.
  • Knowledge of utilization management principles, medical necessity criteria, CMS regulations, and commercial payer requirements.
  • Ability to interpret clinical, financial, and utilization data to support evidence-based decision making.
  • Commitment to quality improvement, patient-centered care, and continuous process improvement.
Why Hartford HealthCare?
At Hartford HealthCare, physicians benefit from:
  • A physician-led, collaborative culture.
  • Opportunities to lead system-wide initiatives that improve patient care and operational excellence.
  • Access to robust physician leadership and professional development programs.
  • Competitive compensation and comprehensive benefits.
  • A commitment to physician wellness and work-life balance.
  • The opportunity to practice within one of New England's premier integrated healthcare systems while enjoying everything Connecticut has to offer-including outstanding schools, vibrant communities, beautiful shoreline, and convenient access to both Boston and New York City.
Join Hartford HealthCare and help shape the future of healthcare through clinical leadership, innovation, and collaboration-because every moment matters.
We invite you to learn more by reaching out to:
Pamela Lasser, Physician Recruiter, at pamela.lasser@hhchealth.org .
Qualifications:
Qualifications
Education
  • Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
Experience
  • Minimum 5 years of acute care clinical experience required (Hospital based)
  • 3 years or more of prior physician advisor experience or utilization management/managed care experience required.
Licensure
  • Unrestricted Connecticut medical license (or eligibility to obtain one).
Hartford HealthCare at Home logo

About Hartford HealthCare at Home

Sourced by ZipRecruiter

Hartford HealthCare at Home, based in Wethersfield, Connecticut, US, is a premier provider in the healthcare industry, specifically in home-based care services. Their official website can be accessed at hartfordhealthcareathome.org. They offer a wide range of services including nursing, physical therapy, occupational therapy, speech therapy, social work, and home health aid. The company was established with the mission to enhance the capability of people to achieve optimal health and wellbeing through its home care services. They maintain a patient-centric approach and belief in making a real difference in people's lives. As an integral part of Hartford HealthCare, they share the vision to be “most trusted for personalized coordinated care”.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Wethersfield, CT, US

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