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Utilization Management Jobs in Bethlehem, PA (NOW HIRING)

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Utilization Management information

See Bethlehem, PA salary details

$38.5K

$88.4K

$161.1K

How much do utilization management jobs pay per year?

As of Sep 6, 2026, the average yearly pay for utilization management in Bethlehem, PA is $88,416.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,700.00 and $103,300.00 per year, depending on experience, location, and employer.

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 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 degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

What are popular job titles related to Utilization Management jobs in Bethlehem, PA?

For Utilization Management jobs in Bethlehem, PA, the most frequently searched job titles are:

What job categories do people searching Utilization Management jobs in Bethlehem, PA look for?

The top searched job categories for Utilization Management jobs in Bethlehem, PA are:

What cities near Bethlehem, PA are hiring for Utilization Management jobs?

Cities near Bethlehem, PA with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Bethlehem, PA as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, 2% Contract, and 1% Nights. Highlights an 82% Physical, 2% Hybrid, and 16% Remote job distribution, with an average salary of $88,416 per year, or $42.5 per hour.

Care Manager/ Case Manager

Good Shepherd Rehabilitation Network

Center Valley, PA • On-site

Per diem

Re-posted 9 days ago

Good Shepherd Rehabilitation rating

6.5

Company rating: 6.5 out of 10

Based on 17 frontline employees who took The Breakroom Quiz

Job description

  • JOB SUMMARY
    • Develops an integrated link between patients, families, local resources, insurance representatives and hospital, enhances communication among these parties to assure appropriate and timely utilization and access to services and exchange of information, therapeutic interventions and advocates for the rights and needs of patients.
  • ESSENTIAL FUNCTIONS
    • ASCERTAINS PATIENT'S MEDICAL, PSYCHOLOGICAL, EMOTIONAL AND SOCIAL NEEDS
      • By interviewing patient, completing initial care management assessment, screening for potential discharge planning needs, communicating with treatment team.
    • DEVELOPS THERAPEUTIC INTERVENTION PLAN ACCORDING TO NEEDS
      • By exploring options, setting goals, establishing rapport with patient and significant others.
    • OBTAINS SERVICES AND RESOURCES FOR PATIENT
      • By ascertaining appropriateness and referring to community resources
      • Establishing rapport with agencies and support groups
      • Arranging appointments
    • REPRESENTS RIGHTS AND NEEDS OF PATIENTS
      • By educating and informing patients about their rights
      • Advocating on their behalf with community resources, insurers, treatment team
    • COORDINATES TREATMENT AND DISCHARGE PLAN
      • By leading interdisciplinary team meetings
      • Bridging communication between team members, ancillary departments, insurers and significant others.
    • MAINTAINS DOCUMENTATION
      • By appropriate and timely notations in the medical record, departmental files, hand-off communication documents (i.e. POD report), electronic documentation systems and databases.
    • ADDRESSES PATIENT SAFETY
      • By identifying and communicating patient safety issues to the team, patient/family
      • Relaying recommendations for a safe discharge plan to patient/family
      • Assisting to resolve care issues by making referrals to address identified needs
      • Reporting to regulatory agencies as required, facilitating appropriate utilization of services.
    • Coordinates UTILIZATION MANAGEMENT ProcessES
      • By reviewing clinical information based upon admission and continued stay criteria
      • Performing concurrent medical reviews to communicate to payers
      • Initiating physician advisor reviews for cases not meeting established criteria for admission and/or continued stay to facilitate appropriate utilization of services
      • Communicating denials from third party payers to the physician and coordinating a timely appeals process
      • Updating demographic information,
      • Obtaining signatures on admission paperwork and/or advance directives forms (where applicable)
    • DEMONSTRATES A PROFESSIONAL DEMEANOR AND MAINTAINS PROFESSIONAL KNOWLEDGE
      • By being flexible, responding positively to unexpected changes in the work load and work hours
      • Performing other duties as directed
      • Keeping abreast of regulations and policies related to utilization management and discharge planning, departmental staff meeting information.
  • QUALIFICATIONS
    • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
      • Education
        • Bachelor's Degree required
        • Master's Degree preferred
      • Work Experience
        • 1-2 years of related experience required
      • Licenses / Certifications
        • Clinical license in appropriate discipline preferred.

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