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How much do utilization management rep jobs pay per hour?

As of May 30, 2026, the average hourly pay for utilization management rep in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Utilization Management Representative, and why are they important?

To thrive as a Utilization Management Representative, you need a solid understanding of healthcare policies, medical terminology, and insurance processes, typically supported by a background in healthcare administration or a related field. Familiarity with utilization review software, electronic medical records (EMR), and claims management systems is typically required. Strong attention to detail, effective communication, and customer service skills help you excel when coordinating between providers, members, and insurance teams. These competencies ensure accurate case review, regulatory compliance, and positive patient outcomes in a complex healthcare environment.

How does a Utilization Management Rep collaborate with healthcare providers and internal teams to ensure appropriate patient care?

A Utilization Management Rep frequently interacts with healthcare providers, such as physicians and nurses, to gather clinical information and clarify treatment plans. They also work closely with internal medical directors, case managers, and claims teams to review authorization requests and determine medical necessity based on established guidelines. Effective communication and teamwork are key, as the role requires balancing patient needs, provider requests, and payer policies to facilitate timely, appropriate care decisions. This collaboration ensures that patients receive necessary services while helping to control healthcare costs.

What is a Utilization Management Rep?

A Utilization Management Representative, often called a UM Rep, is a professional who reviews medical service requests to ensure that treatments and procedures are medically necessary and covered by a patient's insurance plan. They work with healthcare providers, insurance companies, and patients to review clinical information, authorize care, and sometimes suggest alternative treatments based on policy guidelines. UM Reps play a key role in managing healthcare costs while maintaining quality care by adhering to established criteria and regulations.

What is the difference between Utilization Management Rep vs Utilization Review Coordinator?

AspectUtilization Management RepUtilization Review Coordinator
CertificationsCPUR, RHIT, or similarCPUR, RHIT, or similar
Work EnvironmentHealthcare insurance companies, hospitalsHealthcare insurance companies, hospitals
Job FocusReviewing and authorizing healthcare servicesCoordinating and managing review processes

Both roles involve reviewing healthcare services, often requiring similar certifications. The Utilization Management Rep primarily assesses and authorizes services, while the Utilization Review Coordinator manages the review process and coordinates between providers and payers. They often work in similar environments within the healthcare insurance industry, with overlapping responsibilities but different focus areas.

More about Utilization Management Rep jobs
What states have the most Utilization Management Rep jobs? States with the most job openings for Utilization Management Rep jobs include:
What job categories do people searching Utilization Management Rep jobs look for? The top searched job categories for Utilization Management Rep jobs are:
Utilization Management Rep jobs near you
Utilization Mgmt Rep- Per Diem (As Needed)

Utilization Mgmt Rep- Per Diem (As Needed)

Advocate Aurora Health

Oak Brook, IL • On-site

$20.80 - $31.20/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 20 days ago

Advocate Aurora Health rating

7.6

Company rating: 7.6 out of 10

Based on 762 frontline employees who took The Breakroom Quiz

182nd of 864 rated healthcare providers

Job description

Department:

11215 Advocate Aurora Health Corporate - Utilization Management

Status:

Part time

Benefits Eligible:

No

Hours Per Week:

0

Schedule Details/Additional Information:

1 day /week and then potentially more based on staffing needs

1 weekend shift per month and 1 summer and 1 winter holiday

Pay Range

$20.80 - $31.20Major Responsibilities: Manage incoming fax, phone, and portal communications or any other requests from internal and external customers pertaining to clinical requests, approvals, authorizations, and denials; determine action required, and document all activities performed accurately and clearly in the designated database/area(s) of EHR. Communicate clinical needs, authorizations, and denials to the Utilization Review Nurses and Managers for follow up Verify insurance information provided by callers, fax, or Portal and send information to payers as requested, including discharge dates and disposition or clinical reviews/summaries prepared by UM RNs (if directed to do), while ensuring that all actions taken align/comply with the confidentiality and HIPAA compliance guidelines Follow up with payers to validate the authorization and confirm the days approved, and capture approved days in the EHR Enter data into database, spreadsheets, and perform analysis as directed. Provide efficient, courteous, and expert customer service to all internal and external callers. Open, sort, and process incoming mail/correspondence directed to the Utilization Review. Maintain the department records and files. Ensure provider compliance with Patient Status Admit Order (PSAO) co-signatures across the hospital sites covered by centralized UM. Utilize standard reports/patient lists withing the EHR to identify PSAO co-signature delinquencies and follow up with reminders/escalations to physicians to sign admission orders Follow the standard process to notify treating physician via perfect serve or other approved/designated methods of communication. Interact with Site and System Physician Advisors based on guidelines for escalation. Document all actions taken and status updates in the EHR. Maintain PSAO spreadsheet to track signature requests. Provide support and instruction to physicians to assist in the LOC order signature process. Education/Experience Required:Level of Education: High School Graduate or equivalent and 4+ years secretarial experience or Associates Degree Years of Experience: 2+ years of secretarial experience - preferably in a medical environment Knowledge, Skills & Abilities Required:Competent in advanced functions with Microsoft Outlook, Word, Power Point, Excel and complete basic reporting Type 55+ words per minute Strong critical thinking and communication skills to problem solve, and interact with colleagues, physician and payers. Ability to foster and maintain effective professional relationships, manage conflict while demonstrating Advocate Aurora's Behaviors of Excellence at all times Ability to be flexible and function well in a fast paced, continually changing environment. Assume responsibility for self-development by seeking out opportunities for growth and be an active participant in department, site and system initiatives. Comply with strict adherence to predetermined procedures and processes, safety, compliance and privacy/HIPAA guidelines. License/Registration/Certification: N/A Physical Requirements and Working Conditions: This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our CommitmenttoYou:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

  • Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
  • Premium pay such as shift, on call, and more based on a teammate's job
  • Incentive pay for select positions
  • Opportunity for annual increases based on performance

Benefits and more

  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, andShort- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

What Advocate Aurora Health employees say

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Benefits

Hours and flexibility

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About Advocate Health

Sourced by ZipRecruiter

Advocate Healthcare, based in Oak Lawn, Illinois, United States, is a leading figure in the health care industry. Accessible via their official website, 'advocatehealth.com', this organization provides a wide variety of medical services and treatment options. Founded in 1995 through a merger of Evangelical Health Systems Corporation and Lutheran General HealthSystem, Advocate Healthcare has grown exponentially over the years. Now, it operates more than 400 sites of care, including 12 hospitals that encompass 11 acute care hospitals, the state’s largest integrated children’s network, five Level I trauma centers, and three Level II trauma centers. Upholding their values of equality, compassion, excellence, partnership and stewardship, Advocate Healthcare's mission is centered on building lifelong relationships with patients by delivering the best health outcomes and highest level of service through an integrated approach to care and wellness.

Industry

Hospitals and health care and social assistance

Company size

10,000+ Employees

Headquarters location

Charlotte, NC, US

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