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Utilization Management Representative information

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$24.5K

$44.2K

$77K

How much do utilization management representative jobs pay per year?

As of Jul 18, 2026, the average yearly pay for utilization management representative in the United States is $44,219.00, according to ZipRecruiter salary data. Most workers in this role earn between $37,500.00 and $43,000.00 per year, depending on experience, location, and employer.

What are some common challenges Utilization Management Representatives face when coordinating care with healthcare providers?

Utilization Management Representatives often encounter challenges such as navigating differing opinions between healthcare providers and insurance guidelines, handling high caseloads, and ensuring timely communication among all parties. They must balance advocating for patient care with adhering to coverage policies, which can sometimes require negotiation and problem-solving skills. Staying organized and keeping up with regulatory changes are also important to effectively manage these complexities and provide quality support to both patients and providers.

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

AspectUtilization Management RepresentativeUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or CUCOften requires similar certifications, such as CCM or RHIT
Work EnvironmentWorks in insurance companies, healthcare providers, or managed care organizationsWorks in hospitals, clinics, or insurance settings
Job FocusEvaluates medical necessity and authorizes servicesCoordinates review processes and communicates with providers

Both roles involve reviewing healthcare services, but the Utilization Management Representative primarily assesses medical necessity and authorizes care, while the Utilization Review Coordinator manages the review process and liaises with providers. They share similar certifications and work environments, making them closely related in the healthcare utilization management field.

What is the most chill healthcare job?

A Utilization Management Representative typically has a predictable schedule, often works in an office environment, and requires minimal physical activity, making it a relatively low-stress healthcare role. The job involves reviewing medical cases and authorizations, with opportunities for remote work and standard office hours, contributing to a calmer work setting.

What are Utilization Management Representatives?

Utilization Management Representatives are professionals who review and evaluate medical services to ensure that patients receive appropriate care while managing healthcare costs. They work for insurance companies, healthcare providers, or third-party administrators, and their primary role is to assess the necessity, efficiency, and appropriateness of medical treatments and procedures. They communicate with healthcare providers, review clinical information, and make coverage determinations based on established guidelines. Their work helps balance quality patient care with cost-effective use of healthcare resources.

What jobs pay 4000 a week without a degree?

Utilization Management Representatives typically do not earn $4,000 weekly without a degree, as their roles usually require healthcare or insurance industry knowledge and certifications. High-paying jobs that can reach this level without a degree often include skilled trades like commercial truck driving, sales positions, or entrepreneurship, but these may require experience, licensing, or specialized skills. Most roles paying this amount consistently without a degree are rare and often involve commission, bonuses, or self-employment.

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, insurance procedures, and medical terminology, often supported by a background in healthcare administration or a related field. Familiarity with utilization management software, electronic health records (EHRs), and claims processing systems is typically required. Strong attention to detail, effective communication, and problem-solving skills help professionals excel when interacting with healthcare providers and patients. These skills ensure accurate review of medical necessity, timely authorization of services, and regulatory compliance, all of which are critical for efficient healthcare delivery.

What degree do you need for utilization management?

Utilization Management Representatives typically need at least a high school diploma or equivalent; however, many employers prefer candidates with a bachelor's degree in healthcare, nursing, health administration, or a related field. Relevant certifications and knowledge of medical terminology, insurance processes, and healthcare regulations can also enhance job prospects.

What does a utilization management representative do?

A utilization management representative reviews medical claims and patient records to determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies, often using specialized software, to approve or deny coverage based on established guidelines and policies.
More about Utilization Management Representative jobs
What cities are hiring for Utilization Management Representative jobs? Cities with the most Utilization Management Representative job openings:
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What job categories do people searching Utilization Management Representative jobs look for? The top searched job categories for Utilization Management Representative jobs are:
Utilization Management Representative jobs near you
Infographic showing various Utilization Management Representative job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $44,219 per year, or $21.3 per hour.
Utilization Management Representative I

Utilization Management Representative I

Elevance Health

Atlanta, GA • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago

Elevance Health rating

7.7

Company rating: 7.7 out of 10

Based on 348 frontline employees who took The Breakroom Quiz

183rd of 281 rated insurance

Job description

Utilization Management Representative I

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.


The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.

Hours: Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift hours from 8:30 AM to 5:30 PM Mountain Time. Please adjust for your time zone. Candidates will be required to work rotating weekends and select holidays, and must be flexible and available to work overtime. Weekend shift hours may vary.

How you will make an impact:

  • Managing incoming calls or incoming post services claims work.

  • Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.

  • Refers cases requiring clinical review to a Nurse reviewer.

  • Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.

  • Responds to telephone and written inquiries from clients, providers and in-house departments.

  • Conducts clinical screening process.

  • Authorizes initial set of sessions to provider.

  • Checks benefits for facility based treatment.

  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

  • Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.

  • Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.

  • Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.

  • Performs other duties as assigned.

Minimum Requirements:

  • Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Inbound call center experience strongly preferred.

  • Medical terminology training and experience in medical or insurance field strongly preferred.

  • For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

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