Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Utilization Management Specialist
Tampa, FL · On-site
$23.80/hr
General Purpose of Job To act as a liaison between the Case Management Organizations (CMOs), the Department of Children & Families (DCF) and specialty and/or community providers to facilitate ...
Utilization Management Specialist
Tampa, FL · On-site
$23.80/hr
General Purpose of Job To act as a liaison between the Case Management Organizations (CMOs), the Department of Children & Families (DCF) and specialty and/or community providers to facilitate ...
Utilization Management Registered Nurse
Tampa, FL · On-site
$78K/yr
The Utilization Management (UM) Nurse within the Quality Management Service Line. The incumbent provides clinical review, utilization oversight, and supports the organization's mission by ensuring ...
Utilization Management Registered Nurse
Tampa, FL · On-site
$78K/yr
The Utilization Management (UM) Nurse within the Quality Management Service Line. The incumbent provides clinical review, utilization oversight, and supports the organization's mission by ensuring ...
Inpatient Utilization Management Specialist
$16.50 - $18.50/hr
Coordinate and communicate with the full time utilization management specialist to ensure continuity of authorizations. * Provide coverage to inpatient UM positions when needed. Benefits Full-time * ...
Inpatient Utilization Management Specialist
$16.50 - $18.50/hr
Coordinate and communicate with the full time utilization management specialist to ensure continuity of authorizations. * Provide coverage to inpatient UM positions when needed. Benefits Full-time * ...
Inpatient Utilization Management Specialist
Punta Gorda, FL · On-site
$16.50 - $18.50/hr
Coordinate and communicate with the full time utilization management specialist to ensure continuity of authorizations. * Provide coverage to inpatient UM positions when needed. Benefits Full-time * ...
Inpatient Utilization Management Specialist
Punta Gorda, FL · On-site
$16.50 - $18.50/hr
Coordinate and communicate with the full time utilization management specialist to ensure continuity of authorizations. * Provide coverage to inpatient UM positions when needed. Benefits Full-time * ...
Utilization Management Representative II
Miami, FL · On-site
$16.25 - $19.25/hr
Utilization Management Representative II Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be ...
Utilization Management Representative II
Miami, FL · On-site
$16.25 - $19.25/hr
Utilization Management Representative II Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be ...
Utilization Management Representative II
$16.25 - $19.25/hr
Utilization Management Representative II Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be ...
Utilization Management Representative II
$16.25 - $19.25/hr
Utilization Management Representative II Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be ...
Utilization Management Physician (UMP) Remote | Full-Time | Florida Compensation: $240,000 base + bonus Schedule: 40 hours/week Work Model: Remote (on-site meetings in Daytona Beach, FL ) Overview ...
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Utilization Management Physician (UMP) Remote | Full-Time | Florida Compensation: $240,000 base + bonus Schedule: 40 hours/week Work Model: Remote (on-site meetings in Daytona Beach, FL ) Overview ...
Utilization Management Representative II
Miami, FL · On-site
$16.25 - $19.25/hr
Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday ...
Utilization Management Representative II
Miami, FL · On-site
$16.25 - $19.25/hr
Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday ...
Utilization Management Representative II
$16 - $19.25/hr
Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday ...
Utilization Management Representative II
$16 - $19.25/hr
Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday ...
Utilization Management Representative II
$14.75 - $17.75/hr
Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday ...
Utilization Management Representative II
$14.75 - $17.75/hr
Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday ...
Utilization Management Representative II
$14.75 - $17.75/hr
Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday ...
Utilization Management Representative II
$14.75 - $17.75/hr
Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday ...
Utilization Management Representative II
$16.25 - $19.25/hr
Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday ...
Utilization Management Representative II
$16.25 - $19.25/hr
Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday ...
Utilization Mgmt Case Mgr II
Sarasota, FL · On-site
Department Integrated Case Management Job Summary The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically ...
Utilization Mgmt Case Mgr II
Sarasota, FL · On-site
Department Integrated Case Management Job Summary The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically ...
Front office medical or customer service/utilization management for healthcare company experience preferred. Job Type: Contract to hire Additional Details: * Monday - Friday, 8:00 AM - 5:00 PM EST
Front office medical or customer service/utilization management for healthcare company experience preferred. Job Type: Contract to hire Additional Details: * Monday - Friday, 8:00 AM - 5:00 PM EST
Department Integrated Case Management Job Summary The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically ...
Department Integrated Case Management Job Summary The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically ...
Department Integrated Case Management Job Summary The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically ...
Department Integrated Case Management Job Summary The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically ...
Essential Job Duties • Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract ...
Essential Job Duties • Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract ...
Essential Job Duties Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract ...
Essential Job Duties Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract ...
Utilization Management information
See Florida salary details
$29.1K - $37.6K
15% of jobs
$37.6K - $46K
8% of jobs
$47.2K is the 25th percentile. Wages below this are outliers.
$46K - $54.4K
15% of jobs
The median wage is $59.7K / yr.
$54.4K - $62.8K
20% of jobs
$62.8K - $71.3K
11% of jobs
$75.5K is the 75th percentile. Wages above this are outliers.
$71.3K - $79.7K
13% of jobs
$79.7K - $88.1K
5% of jobs
$88.1K - $96.5K
3% of jobs
$96.5K - $105K
4% of jobs
$105K - $113.4K
3% of jobs
$113.4K - $121.8K
3% of jobs
$29.1K
$66.9K
$121.8K
How much do utilization management jobs pay per year?
What jobs pay 4000 a week without a degree?
What jobs pay $2000 a day?
What are the key skills and qualifications needed to thrive in the Utilization Management position, and why are they important?
To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.
What is a Utilization Management job?
A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.
What is the least stressful healthcare job?
What does utilization management do?
What are the typical daily responsibilities of a Utilization Management professional?
As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.
- Night Utilization Review Nurse
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- Non Exempt No Experience Utilization Management Nurse
- Overnight Utilization Review Nurse
- Weekend Physician Advisor Utilization Review
- Utilization Management Nurse Consultant
- Remote Utilization Management Nurse
- Utilization Management Coordinator
- Manager Optum Utilization Review
- Director Of Case Management
- Remote Supervisor Utilization Management
- Utilization Review Clinician
- Internship Rn Utilization Review Nurse
- Medical Utilization Review Physician
- Remote Rn Chart Review
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- Remote Anthem Utilization Review Nurse

Other
Medical, Dental, Vision, Life, Retirement, PTO
Posted 12 days ago
Elevance Health rating
7.8
Based on 332 frontline employees who took The Breakroom Quiz
165th of 261 rated insurance
Job description
Utilization Management Representative I
Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.
Hours: Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift hours from 8:30 AM to 5:30 PM Mountain Time. Please adjust for your time zone. Candidates will be required to work rotating weekends and select holidays, and must be flexible and available to work overtime. Weekend shift hours may vary.
How you will make an impact:
Managing incoming calls or incoming post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
Refers cases requiring clinical review to a Nurse reviewer.
Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
Responds to telephone and written inquiries from clients, providers and in-house departments.
Conducts clinical screening process.
Authorizes initial set of sessions to provider.
Checks benefits for facility based treatment.
Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
Performs other duties as assigned.
Minimum Requirements:
Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Inbound call center experience strongly preferred.
Medical terminology training and experience in medical or insurance field strongly preferred.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
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About Elevance Health
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Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Indianapolis, IN, US
Year founded
2004