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Utilization Management Specialist Jobs (NOW HIRING)

Ampcus

Spec, Utilization Management

Baltimore, MD · On-site

Baltimore, MD Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness ...

ICONMA

Spec, Utilization Management

Baltimore, MD · On-site

Spec, Utilization Management Our client, a Health Insurance company, is looking for a Spec ... Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist will ...

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How much do utilization management specialist jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for utilization management specialist 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 is a utilization management specialist?

Utilization Management Specialists are healthcare professionals who evaluate the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and admissions. They review patient records, apply clinical guidelines, and often work with insurance companies and healthcare providers to ensure that patients receive appropriate care while managing costs. Their goal is to ensure quality treatment and prevent unnecessary or duplicative services, helping organizations comply with regulations and optimize resource use.

What are the key skills and qualifications needed to thrive as a utilization management specialist?

To thrive as a Utilization Management Specialist, you need a thorough understanding of healthcare regulations, medical terminology, and case review processes, typically supported by a degree in nursing or a related healthcare field. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines and medical necessity criteria are essential. Strong analytical skills, attention to detail, and effective communication help you collaborate with providers and advocate for patient needs. These skills ensure efficient and compliant care decisions that balance patient well-being with cost-effective resource utilization.

How does a utilization management specialist typically collaborate with healthcare providers and insurance companies?

Utilization Management Specialists work closely with both healthcare providers and insurance companies to ensure that patients receive appropriate, cost-effective care. They regularly review medical records, coordinate with physicians to discuss treatment plans, and communicate with insurance representatives to clarify coverage criteria. Effective collaboration involves balancing clinical guidelines with payer policies, and often requires strong negotiation and communication skills. This teamwork is essential to making informed decisions regarding approvals or denials of medical services.

How to become a utilization management specialist?

To become a utilization management specialist, candidates typically need a bachelor's degree in healthcare, nursing, or a related field. Relevant experience in healthcare or insurance, along with knowledge of medical coding and utilization review processes, is often required. Certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Certified Utilization Review Professional (CURP) can enhance job prospects.

What degree do you need for utilization management specialist?

A utilization management specialist typically needs at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ) or Certified Utilization Review Professional (CURP), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and healthcare regulations is also important.
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Utilization Management Specialist jobs near you
Infographic showing various Utilization Management Specialist job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, and 2% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.

Behavioral Health Utilization Management Specialist

Hastings, MI • On-site

Barry County Community Mental Health Aut
See more jobs at Barry County Community Mental Health Autexternal

$58K/yr

Full-time

This job post has expired 3 days ago. Applications are no longer accepted.

Job description

Location: Primarily Remote (Michigan-based)
Schedule: Full-Time | Option for Four-Day Work Week

Position Overview:
We are seeking a detail-oriented and clinically skilled Behavioral Health Utilization Management (UM) Specialist to join our team. This role is responsible for reviewing behavioral health services to ensure medical necessity, regulatory compliance, and appropriate level of care determinations. The ideal candidate brings strong clinical judgment, experience with managed care or utilization management processes, familiarity with Community Mental Health/CMHSP operations, and the ability to work independently in a remote environment.

Key Responsibilities:

  • Conduct utilization reviews for behavioral health services, including initial, concurrent, and retrospective reviews
  • Assess clinical documentation to determine medical necessity and appropriate level of care
  • Ensure compliance with state, federal, and payer-specific regulations and guidelines
  • Collaborate with providers, care teams, and internal stakeholders to support quality service delivery
  • Maintain accurate and timely documentation of all UM activities
  • Participate in audits, quality improvement initiatives, and process enhancements
  • Stay current on best practices, regulatory updates, and industry standards in behavioral health and managed care

Qualifications:

  • Master’s degree in Social Work, Professional Counseling, Psychology, or a related behavioral health field
  • Current, active licensure in the State of Michigan (e.g., LMSW/LLMSW, LPC/LLPC, LLP/TLLP)
  • Prior experience in utilization management, managed care, or similar review functions required
  • Strong attention to detail and critical thinking skills
  • Excellent written and verbal communication abilities
  • Ability to work independently while managing multiple priorities

Preferred Qualifications:

  • Experience with behavioral health payer guidelines and authorization processes
  • Familiarity with electronic health records and UM software systems

What We Offer:

  • Four-day work week promoting work-life balance
  • Primarily remote work environment with flexible scheduling
  • Collaborative and mission-driven team culture
  • Opportunities for professional growth and development

How to Apply:
 Interested candidates should submit a resume and cover letter outlining their relevant experience and licensure status.

We are an equal opportunity employer committed to diversity, equity, and inclusion in the workplace.