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Utilization Management Team Lead Jobs (NOW HIRING)

UHS

Utilization Management Coordinator

Houston, TX

West Oaks Hospital is seeking a dynamic and talented Utilization Management Coordinator to join our team of compassionate, dedicated professionals. The Utilization Management Coordinator provides ...

Corewell Health

Utilization Mgmt Spec

Southfield, MI · Hybrid

About Corewell Health As a team member at Corewell Health, you will play an essential role in ... Name Utilization Management - Diversified East WB Mkt Employment Type Full time Shift Day (United ...

JLL

Project Management Team Lead

Worcester, MA

Lead, train, manage and develop your assigned team * Integrate with Regional Leadership and other JLL Service Lines (Finance, Sourcing, Facility Management, Engineering, Occupancy Planning ...

CBRE

Project Management Team Lead

Greenville, SC · On-site

As a Project Management Team Lead, you'll manage a team responsible for providing advanced management and consultancy services four Carolina's market accounts to achieve the company's strategic ...

JLL

Project Management Team Lead

Boston, MA

Lead, train, manage and develop your assigned team * Integrate with Regional Leadership and other JLL Service Lines (Finance, Sourcing, Facility Management, Engineering, Occupancy Planning ...

Genesis HealthCare

Acts as part of a multidisciplinary team including Genesis Financial and Reimbursement Services ... Utilization Management analyzes and trends information and data in order to optimize efficiency of ...

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Utilization Management Team Lead information

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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.

Registered Nurse Director of System Utilization

JSA

Metairie, LA

Full-time

Posted 11 days ago

Job description

Director, System Utilization Management - RN - Job Opening - Urgent!!!! We are helping a large health system (over 8 hospitals) who is looking for a Director, System Utilization Management - RN to join their team in the Southeast!!! The Director, System Utilization Management (UM) provides strategic and operational leadership for utilization review, and resource management functions across the health system.

This role ensures appropriate use of healthcare services, regulatory compliance, and optimal reimbursement, across all facilities and service lines. The Director oversees day-to-day utilization review operations, establishes standardized processes and best practices, and drives organizational alignment to promote cost-effective care. Working collaboratively with clinical, operational, and revenue cycle leadership, this position advances performance improvement initiatives, reduces denials, and strengthens financial and regulatory outcomes across the system.

GENERAL DUTIES: 1. Strategic Leadership In conjunction with the Corp VP, Case Management & Utilization, develop and implement a system-wide utilization management strategy aligned with organizational goals. Lead standardization of UM processes across hospitals.

Collaborate with executive leadership and Case Management to reduce denials, prevent avoidable days, and optimize length of stay (LOS). Identify trends and implement performance improvement initiatives to enhance clinical and financial outcomes. Develop a culture of high performance and continuous improvement that values learning and a commitment to quality, including conducting routine, ongoing audits to ensure with UM established policies and procedures.

2. Regulatory & Compliance Oversight Ensure compliance with federal, state, and payer regulations along with all relevant accreditation and regulatory requirements. Oversee adherence to InterQual or MCG criteria for medical necessity determinations.

Ensure compliance with third party payor requirements, both governmental and commercial payors. 3. Revenue Cycle Integration Partner with Revenue Cycle, Finance, and Managed Care teams to reduce payer denials and improve reimbursement.

Monitor denial trends and lead root cause analysis and corrective action plans. Oversee appeals processes and ensure timely documentation to support medical necessity. Collaborate with the Physician Advisor Team to both reduce denials and identify areas for clinical documentation improvement; collaborate with the Clinical Documentation Integrity Team (“CDI”) on documentation improvement initiatives.

4. Clinical Operations Oversight Direct inpatient and outpatient utilization review activities. Ensure effective communication between physicians, nursing, and payers.

5. Data Analytics & Performance Improvement Analyze system-level data including but not limited to LOS, readmissions, avoidable days, denial rates, and throughput. Develop dashboards and KPIs to track performance.

Lead multidisciplinary committees focused on utilization and throughput optimization. 6. Team Leadership & Development Provide direct oversight to UM manager and clinical review staff.

Establish productivity benchmarks and quality standards. Mentor leaders and promote professional development. EDUCATION QUALIFICATIONS: Bachelor’s degree in nursing, required (master’s preferred).

EXPERIENCE QUALIFICATIONS: 7–10+ years of progressive leadership experience in Utilization Management or Case Management. Experience in multi-hospital or system-level leadership preferred. Strong knowledge of payer requirements, CMS regulations, and accreditation standards.

In depth working knowledge and experience of the EPIC Electronic Health Record System Utilization Management workflows, WQs and data reporting capabilities. LICENSES AND CERTIFICATIONS: Active RN license (if clinical background). Certification in Case Management and/or Utilization Management preferred.

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