Primary Responsibilities The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and ...
Primary Responsibilities The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and ...
Primary Responsibilities The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and ...
Primary Responsibilities The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer review. This ...
Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer review. This ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Social Worker - Utilization Management Team COMPANY OVERVIEW At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to ...
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Social Worker - Utilization Management Team COMPANY OVERVIEW At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to ...
Social Worker - Utilization Management Team COMPANY OVERVIEW At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to ...
Social Worker - Utilization Management Team COMPANY OVERVIEW At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to ...
Contribute to the development, review, and revision of medical policies, clinical guidelines, and utilization management protocols. * Participate in quality improvement initiatives, audits, and ...
Contribute to the development, review, and revision of medical policies, clinical guidelines, and utilization management protocols. * Participate in quality improvement initiatives, audits, and ...
Medical Director, Utilization Review
Austin, TX ยท On-site +1
$260K - $280K/yr
Contribute to the development, review, and revision of medical policies, clinical guidelines, and utilization management protocols. * Participate in quality improvement initiatives, audits, and ...
Medical Director, Utilization Review
Austin, TX ยท On-site +1
$260K - $280K/yr
Contribute to the development, review, and revision of medical policies, clinical guidelines, and utilization management protocols. * Participate in quality improvement initiatives, audits, and ...
Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... Role Summary Advise clients on network strategy, utilization performance, and provider market ...
Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... Role Summary Advise clients on network strategy, utilization performance, and provider market ...
Contribute to the development, review, and revision of medical policies, clinical guidelines, and utilization management protocols. * Participate in quality improvement initiatives, audits, and ...
Contribute to the development, review, and revision of medical policies, clinical guidelines, and utilization management protocols. * Participate in quality improvement initiatives, audits, and ...
Medical Director, Utilization Review
Austin, TX ยท On-site
$180 - $250/hr
Contribute to the development, review, and revision of medical policies, clinical guidelines, and utilization management protocols. * Participate in quality improvement initiatives, audits, and ...
Medical Director, Utilization Review
Austin, TX ยท On-site
$180 - $250/hr
Contribute to the development, review, and revision of medical policies, clinical guidelines, and utilization management protocols. * Participate in quality improvement initiatives, audits, and ...
Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise ...
Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise ...
This position is responsible for working with insurance companies and managed care systems for the ... Previous experience in utilization review or case management desirable. This position will obtain ...
This position is responsible for working with insurance companies and managed care systems for the ... Previous experience in utilization review or case management desirable. This position will obtain ...
This position is responsible for working with insurance companies and managed care systems for the ... Previous experience in utilization review or case management desirable. This position will obtain ...
Quick apply
This position is responsible for working with insurance companies and managed care systems for the ... Previous experience in utilization review or case management desirable. This position will obtain ...
This position is responsible for working with insurance companies and managed care systems for the ... Previous experience in utilization review or case management desirable. This position will obtain ...
This position is responsible for working with insurance companies and managed care systems for the ... Previous experience in utilization review or case management desirable. This position will obtain ...
AUSTIN TX Utilization Review RN
Austin, TX ยท On-site
$35 - $40/hr
Collaborate with physicians, case managers, and healthcare teams to coordinate patient care plans ... Prior utilization review, case management, or managed care experience strongly preferred
Quick apply
AUSTIN TX Utilization Review RN
Austin, TX ยท On-site
$35 - $40/hr
Collaborate with physicians, case managers, and healthcare teams to coordinate patient care plans ... Prior utilization review, case management, or managed care experience strongly preferred
Manager of Paralegal Services
Austin, TX ยท Hybrid
Partner with Human Resources on employee relations, performance management, and talent development. * Monitor utilization, workload, productivity, and staffing across offices and practice groups.
New
Manager of Paralegal Services
Austin, TX ยท Hybrid
Partner with Human Resources on employee relations, performance management, and talent development. * Monitor utilization, workload, productivity, and staffing across offices and practice groups.
New
Manager of Paralegal Services
Austin, TX ยท On-site
Partner with Human Resources on employee relations, performance management, and talent development. * Monitor utilization, workload, productivity, and staffing across offices and practice groups.
New
Manager of Paralegal Services
Austin, TX ยท On-site
Partner with Human Resources on employee relations, performance management, and talent development. * Monitor utilization, workload, productivity, and staffing across offices and practice groups.
New
Utilization Management information
See Austin, TX salary details
$38.7K - $49.8K
15% of jobs
$49.8K - $61K
8% of jobs
$62.6K is the 25th percentile. Wages below this are outliers.
$61K - $72.2K
15% of jobs
The median wage is $79.2K / yr.
$72.2K - $83.4K
20% of jobs
$83.4K - $94.5K
11% of jobs
$100.1K is the 75th percentile. Wages above this are outliers.
$94.5K - $105.7K
13% of jobs
$105.7K - $116.9K
5% of jobs
$116.9K - $128K
3% of jobs
$128K - $139.2K
4% of jobs
$139.2K - $150.4K
3% of jobs
$150.4K - $161.6K
3% of jobs
$38.7K
$88.7K
$161.6K
How much do utilization management jobs pay per year?
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 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.
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- Seasonal Remote Hedis Review Nurse
- Evening Optum Health Utilization Review
- Insurance Utilization Review
- Utilization Review Manager
- Weekend Utilization Review
- Aetna Utilization Review Nurse
- Chart Utilization Review
- Utilization Review Assistant
- Per Diem Remote Occupational Therapy Utilization Review
- Remote Bcba Utilization Review
- Utilization Review Nurse Compact License
- Full Time Cigna Utilization Review Nurse

Full-time
This job post hasย expired today.ย Applications are no longer accepted.
Job description
The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and compliance with state mandated regulations.
Essential Functions
โข Perform concurrent, retroactive and pre-service authorization reviews for inpatient and outpatient services.
โข Follow and maintain compliance with CMS requirements, may include after-hours, holiday and weekend coverage.
โข Collaborate with staff, physicians, care/service coordinators, and medical directors to coordinate and provide the level of care necessary to meet member's health need.
Location Requirements
This position is remote but requires the employee to live within our service area, which can include any of the following areas within Texas: Rio Grande Valley, DFW, greater Austin, greater Houston, greater San Antonio, Coastal Bend, or Laredo.
Educational/Training Requirements
- Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience.
- Payor Utilization Management: 3 years recommended experience
- Proficiency with Microsoft Office applications, specifically Word, Excel, and Outlook
- Proficiency using Milliman Care Guidelines (MCG) and/ or InterQual criteria.
Licensing Requirements
- Current unencumbered LVN or RN license in Texas or compact license.
Experience Requirements
- 2+ years Utilization management experience with a health insurance company (managed care/payer experience required).
- UM for Medicare Advantage, Managed Medicaid, Dual SNP Lines of Business, on the payer side.
- 5+ years of acute clinical experience.
- The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.