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Utilization Management Um Specialist Jobs (NOW HIRING)

OncoHealth

Utilization Management (UM) Trainer

... Utilization Management team members. This role ensures employees are equipped with the knowledge ... Create consolidated training materials and framework for onboarding of CRS (Case Review Specialist ...

Oncohealth CORP

Utilization Management (UM) Trainer

... Utilization Management team members. This role ensures employees are equipped with the knowledge ... Create consolidated training materials and framework for onboarding of CRS (Case Review Specialist ...

New Vista Behavioral Health

UM Specialist

Cincinnati, OH · On-site

$24 - $32/hr

UM Specialist Pay: $24 - $32hr Location: 10123 Alliance Road, Cincinnati, Ohio 45242 Schedule ... The Role Itself The Utilization Management Appeals Specialist is responsible for the appeals of ...

Tryfacta, Inc.

RN UM

Franklin, NH · On-site

Coordinate and perform utilization management (UM) activities, including admission, continued stay, and discharge reviews in accordance with facility policies and payer guidelines. * Assess medical ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Perform outpatient utilization management (UM) and medical necessity reviews for prior authorization and precertification requests. * Review clinical documentation and determine benefit eligibility ...

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Utilization Management Um Specialist information

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How much do utilization management um specialist jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for utilization management um 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.

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For Utilization Management Um Specialist jobs, the most frequently searched job titles are:

Behavioral Health Utilization Management Specialist

Barry County Community Mental Health Aut

Hastings, MI • On-site

$58K/yr

Full-time

Re-posted yesterday

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.