ZipRecruiter

Log In

1

Utilization Management Team Lead Jobs (NOW HIRING)

UHS

Utilization Management Coordinator

Forest Park, IL · On-site

... team at Riveredge Hospital. Bring your compassion, expertise, enthusiasm, and passion for quality ... We are currently seeking an Utilization Management Coordinator position for Riveredge Hospital.

AnMed

Utilization Management Specialist II

Anderson, SC · On-site

... lead, and make a meaningful impact here. This position is responsible for performing the daily ... Performs assigned utilization management functions daily: initial, concurrent and retrospective ...

next page

Showing results 1-20

All JobsUtilization Management Team Lead Jobs

Utilization Management Team Lead information

See salary details

$10

$25

$72

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

As of Jul 4, 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 June 2026, with employment types broken down into 79% Full Time, 20% Part Time, and 1% Contract. 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

Utilization Management Nurse

SIHO Insurance Services

Columbus, IN

Full-time

Posted 6 days ago

Job description

Job Title:  Utilization Management Nurse
Reports To: Manager of Utilization Management
Employment Type:  Full-Time, Exempt 

Brief Description of Duties:     
This position is reserved for a licensed Registered Nurse who will perform the Utilization Management (UM) services for SIHO (and affiliated business lines’) members. This individual’s primary role is to ensure that health care services are administered with quality, cost effectiveness, and compliance to plan guidelines are maintained. By performing review of services prospectively, retrospectively, and throughout the episode of care, the UM nurse will make coverage determinations influencing how services are allocated to SIHO’s various member populations.  A candidate’s ability to perform quality reviews within strict efficiency standards is required for this position.  Key responsibilities are as follows: 
- Pre-service, concurrent, and post-service review of necessity of health care services utilizing enrollee medical records and established guidelines set by SIHO and/or state and federal (CMS) guidelines
- Interaction with the member, health care provider, and/or other care team members to complete reviews in most time-efficient manner
- Interaction with the SIHO Medical Director as needed to ensure proper medical necessity decisions are made in a timely manner
- Appropriate documentation of the entire review process utilizing the established documentation system and desk procedures to guarantee accurate reporting metrics and data integrity
- Complete case review and elevation to determinations that are rendered within the contractual and regulatory turnaround times established by SIHO and CMS
- Assist to resolve problems and provide guidance to members of the team and cohorts
-Interpret and abide by organizational policies and procedures; review work regularly to ensure that policies and guidelines are appropriately applied
-Act as a clinical resource to the department and other organization members for services pertaining to medical management, utilization review, and medical necessity
- Act and perform within the scope of professional nursing practice; is responsible in supporting and participating in department strategies and efforts focused on quality improvement
- Responsible for the early identification and assessment of members for inclusion in disease management or care management programs
- Assist in the identification and reporting of Potential Quality of Care concerns and Fraud, Waste and Abuse incidents
- Work as an interdisciplinary team member within Medical Management for all lines of business and commercial group plans 

Minimum Skills Requirement: 
- Registered Nurse with current, unrestricted license in primary state of employment (position may require additional licensing in other states as necessary)Previous UM or Health Plan experience highly preferred
- Desire to work in a fast-paced environment with focus on efficiency while maintaining quality
- Self-directed organization and prioritization skills, and independent time management skills required
- Sound clinical background with experience in the clinical field
- Excellent verbal and written communication skills
- Microsoft Office Experience: Outlook, Word, Excel

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.