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Utilization Management Team Lead information

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$10

$25

$72

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

As of Jun 8, 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.
More about Utilization Management Team Lead jobs
What states have the most Utilization Management Team Lead jobs? States with the most job openings for Utilization Management Team Lead jobs include:
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 May 2026, with employment types broken down into 1% As Needed, 94% Full Time, 4% Part Time, and 1% Temporary. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $53,524 per year, or $25.7 per hour.
Utilization Management Nurse Team Lead

Utilization Management Nurse Team Lead

HealthOne Alliance

Dalton, GA • On-site

$30.25 - $40.75/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 25 days ago

Job description

MISSION
Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.
VALUES
HealthOne is guided by a cultural framework that embodies our values and drives our decisions.
Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.
HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.
JOB PURPOSE
The UM Nurse Team Lead ensures efficient, cost effective, and high quality delivery of utilization review service by supporting and training a staff of registered nurses; to oversee the management of medical cases worked by registered nurses; to oversee individual and overall results/outcomes of all cases within their scope of responsibilities; and to ensure customer satisfaction through the provision of cost effective and high quality utilization review service that meets their needs.
ESSENTIAL JOB DUTIES
• Serve as a clinical and operational team lead for Utilization Management nurses, providing day to day guidance, mentorship, and clinical support
• Act as an escalation resource for complex utilization reviews, appeals, and provider/member issues requiring advanced clinical judgment
• Trains and develops utilization review staff
• Works with Utilization Management Manager to establish and ensure achievement of completion of prior authorization reviews, productivity, and quality goals
• Initiate referrals to ensure appropriate coordination of care
• Seek the advice of the Medical Director when appropriate, according to policy
• Assists non-clinical staff in performance of administrative reviews
• Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility
• Maintains regular and predictable attendance
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
• Works to encourage and promote Company culture throughout the organization
• Other duties as may be assigned
QUALIFICATIONS
• 3 years Clinical experience preferred
• 2 years of Utilization Review
• Proficient in Microsoft Office (Outlook, Word, Excel)
• Working knowledge of NCQA preferred
• Must be able to work in an independent and creative manner
• Ability to manage multiple projects and priorities
• Adaptive to high pace and changing environment
• Customer service oriented
• Proficient in interpreting benefits, contract language and medical policy/medical review criteria
• Current, active Compact State license in Nursing (RN)
PHYSICAL REQUIREMENTS
Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.
BENEFITS
401K (4% Match, Immediate Vesting)
Accident insurance
Competitive salary
Critical Illness Insurance
Dental Insurance
Employee Assistance Program
Flexible Spending Account
Health & Wellness Program
Health Savings Account
Life & AD&D Insurance
Long Term Disability
Medical Insurance
Paid Time Off
Pet Insurance
Short Term Disability
Vision Insurance
PRE-EMPLOYMENT SCREENING
Drug Screen and Background Check Required
HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.

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