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Utilization Management Team Lead Jobs (NOW HIRING)

Centene

Supervisor, Utilization Management (RN)

Florissant, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises day-to-day activities of utilization management team. * Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards * Collaborates ...

Centene

Supervisor, Utilization Management (RN)

Columbia, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Collaborates with utilization management team to resolve complex care member issues * Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization ...

Centene

Supervisor, Utilization Management (RN)

Columbia, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Collaborates with utilization management team to resolve complex care member issues * Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization ...

Centene

Supervisor, Utilization Management (RN)

Saint Louis, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Collaborates with utilization management team to resolve complex care member issues * Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization ...

Intus, Inc

Utilization Management Nurse

$80K - $95K/yr

  • Medical

  • Dental

  • Vision

Concurrent review of all subacute and SNF admissions with the Interdisciplinary Team driving ... the Intus Care Utilization Management Nurse will lead the provider appeals process.

Allmed Staffing Inc

Utilization Management Rep

Pearland, TX · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

Team Environment The selected candidate will join a collaborative Utilization Management team consisting of approximately 20 Utilization Management Representatives (UMRs) working alongside clinical ...

Imedica

Supervisor, Utilization Management

Madison, WI · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

We're a team that owns our work with accountability, makes data-driven decisions, embraces ... This role oversees utilization management projects, initiates and participates in quality ...

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All JobsUtilization Management Team Lead Jobs

Utilization Management Team Lead information

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$72

How much do utilization management team lead jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for utilization management team lead in the United States is $25.73, according to ZipRecruiter salary data. Most workers in this role earn between $15.38 and $24.04 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a utilization management team lead, and why are they important?

To thrive as a Utilization Management Team Lead, you need a background in healthcare, strong knowledge of utilization review processes, and typically a degree in nursing or a related field with relevant licensure or certification. Familiarity with case management software, medical coding systems, and payer guidelines is essential for effective oversight. Strong leadership, critical thinking, and communication skills are vital for guiding teams and collaborating with various stakeholders. These skills ensure compliance, efficient care coordination, and optimal resource utilization within healthcare organizations.

What is the difference between Utilization Management Team Lead vs Utilization Review Nurse?

AspectUtilization Management Team LeadUtilization Review Nurse
CredentialsRN license, certifications in utilization management or case managementRN license, certifications in utilization review or case management
Work EnvironmentSupervisory role overseeing review teams, administrative tasksPerforming reviews, assessing patient records, direct communication with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentLeadership, team management, utilization review processesReview procedures, case assessments, clinical decision-making

The Utilization Management Team Lead typically oversees review teams and manages utilization review processes, requiring leadership skills and certifications. In contrast, the Utilization Review Nurse focuses on conducting clinical reviews and assessments directly related to patient care. Both roles share similar credentials and work environments but differ mainly in scope and responsibilities.

What are some common challenges faced by a utilization management team lead, and how can they be addressed?

A Utilization Management Team Lead often faces challenges such as balancing workflow efficiencies with regulatory requirements, managing diverse team member skillsets, and ensuring timely case reviews. Addressing these challenges involves fostering clear communication, providing regular training, and implementing effective performance tracking systems. Additionally, collaborating closely with clinical staff and other departments helps ensure consistent application of best practices and supports continuous quality improvement.

What does a utilization management team lead do?

A Utilization Management Team Lead oversees a team responsible for reviewing and evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments. They coordinate daily operations, provide guidance to utilization review staff, and ensure compliance with regulatory guidelines and organizational policies. The Team Lead also communicates with healthcare providers, resolves escalated cases, and monitors performance metrics to optimize resource use and patient outcomes.
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What job categories do people searching Utilization Management Team Lead jobs look for?

The top searched job categories for Utilization Management Team Lead jobs are:

Utilization Management Team Lead jobs near you
Infographic showing various Utilization Management Team Lead job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, and 4% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $53,524 per year, or $25.7 per hour.

Utilization Management (UM) Clinical Team Lead

MetroPlusHealth

Manhattan, NY • On-site

Other

Re-posted 16 days ago

MetroPlusHealth rating

6.7

Company rating: 6.7 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

269th of 308 rated insurance

Job description

Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
About NYC Health + Hospitals
MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.
Position Overview:
The Clinical Team Lead, under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Clinical Team Lead will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.
Work Shifts
9:00 AM - 5:00 PM
Duties & Responsibilities
  • Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established MetroPlusHealth Utilization Management policies, procedures, and protocols.
  • Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
  • Interacts and obtains relevant clinical information from members' PCP and other providers; approves care that meets established criteria; and refers all other cases to the MetroPlusHealth Physician Advisor/Medical Director.
  • Inform member and provider of Utilization Management determinations and treatment alternatives.
  • Identifies utilization trends and potential member needs by means of generating reports of encounter data, pharmacy data review, and new member health assessment forms.
  • Evaluate member needs for referred cases (from providers or member self-referred).
  • Assists all departments with the resolution of members' problems related to utilization management issues.
  • Performs all Utilization Management activities in compliance with all regulatory agency requirements.
  • Conducts medical record reviews as appropriate to case management functions.
  • Participate in Medical Management grand rounds with the Physician Advisor.
  • Performs all other duties as assigned
Minimum Qualifications
  • High School Diploma General Equivalency Diploma (GED) required; and
  • 2-5 years' clinical experience in an acute or applicable care setting.
  • UM/UR experience in managed care or hospital setting required
Licensure and/or Certification Required:
  • Valid New York State license and current registration to practice as a Registered Professional Nurse (RN), License Practical Nurse (LPN), or Physical Therapist (PT) issued by the New York State Education Department (NYSED).
Professional Competencies:
  • Integrity and Trust
  • Customer Focus
  • Excellent communication, written and analytical skills.
  • Knowledge of computer systems.

#LI-Hybrid #MPH50

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