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Utilization Management information

See Rhode Island salary details

$38.2K

$87.6K

$159.6K

How much do utilization management jobs pay per year?

As of Aug 5, 2026, the average yearly pay for utilization management in Rhode Island is $87,631.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,200.00 and $102,300.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in utilization management, 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 utilization management?

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 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.

What are the most commonly searched types of Utilization Management jobs in Rhode Island? The most popular types of Utilization Management jobs in Rhode Island are:
What are popular job titles related to Utilization Management jobs in Rhode Island? For Utilization Management jobs in Rhode Island, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Rhode Island look for? The top searched job categories for Utilization Management jobs in Rhode Island are:
What cities in Rhode Island are hiring for Utilization Management jobs? Cities in Rhode Island with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Rhode Island as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $87,631 per year, or $42.1 per hour.

Utilization Review Nurse

US Tech Solutions

Providence, RI • On-site

Other

Re-posted 10 days ago

Job description

Please note: Actual location may vary., RI

Contract

Job Description:

· Participates in the development and ongoing implementation of QM Work Plan activities.

· Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives

Responsibilities:

· Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.

· Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.

· Data gathering requires navigation through multiple system applications.

· Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.

· Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.

· Responsible for the review and evaluation of clinical information and documentation.

· Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.

· Works Potential Quality of Care cases across all lines of business (Commercial and Medicare).

· Independently coordinates the clinical resolution with internal/external clinician support as required.

· Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data

· Prepares and completes QM documents based on interpretation and application of business requirements

· Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements

· Assists in the development and implementation of QM projects and activities

· Accountable for completing and implementation of QM Work Plan Activities

Experience:

· 3+ years of experience as an RN

· 1+ years of inpatient hospital experience

· Registered Nurse in state of residence

· Must have prior authorization utilization experience

· Able to work in multiple IT platforms/systems

Skills:

· MUST HAVE MEDCOMPASS or ASSURECARE exp.

· MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge.

· MUST HAVE UM experience, inpatient utilization management review.

· MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG.

· MUST HAVE 6 months of Prior Authorization.

Education:

· Active and unrestricted RN licensure in state of residence

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com/) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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About US Tech Solutions

Sourced by ZipRecruiter

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

Social media

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