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Utilization Management Jobs in Chester, PA (NOW HIRING)

IntePros

Utilization Management RN

Philadelphia, PA · On-site

This role is responsible for performing utilization management reviews to determine the medical necessity of requested healthcare services, ensuring members receive appropriate, evidence-based care ...

Enlyte

Utilization Reviewer 2

Wayne, PA · On-site

$52K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective ... Detail-oriented with strong organizational skills to manage multiple cases efficiently.

Enlyte

Utilization Reviewer 2

Wayne, PA · On-site

$52K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective ... Detail-oriented with strong organizational skills to manage multiple cases efficiently.

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Showing results 1-20

All JobsUtilization Management JobsUtilization Management Jobs in Chester, PA

Utilization Management information

See Chester, PA salary details

$37.6K

$86.3K

$157.2K

How much do utilization management jobs pay per year?

As of Sep 5, 2026, the average yearly pay for utilization management in Chester, PA is $86,320.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,200.00 and $100,800.00 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 Chester, PA?

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

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

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

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Chester, PA as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, and 3% Contract. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $86,320 per year, or $41.5 per hour.

Utilization Management RN

IntePros

Philadelphia, PA • On-site

Other

Re-posted 25 days ago

Job description

PA RN License Required


We are seeking an experienced Care Management Coordinator to join our Infusion Therapy team. This role is responsible for performing utilization management reviews to determine the medical necessity of requested healthcare services, ensuring members receive appropriate, evidence-based care while maintaining compliance with regulatory and accreditation standards.

This position is ideal for a clinically strong RN who thrives in a collaborative environment, enjoys critical thinking, and is passionate about improving patient outcomes through high-quality utilization management.


Key Responsibilities

  • Conduct medical necessity reviews for infusion therapy services using InterQual, medical policies, and evidence-based clinical guidelines.
  • Review medical records, treatment plans, and clinical documentation to authorize medically necessary services.
  • Collaborate with physicians and providers to obtain additional clinical information and clarify treatment plans when needed.
  • Present cases that do not meet medical necessity criteria to the Medical Director for final determination.
  • Identify discharge planning needs and collaborate with case management to support appropriate transitions of care.
  • Ensure authorization decisions comply with federal, state, and accreditation requirements while meeting established turnaround times.
  • Identify utilization trends, quality concerns, and opportunities for process improvement.
  • Accurately document all clinical reviews and maintain the integrity of care management systems.
  • Serve as a clinical resource and advocate for members navigating the healthcare system.


Qualifications

  • Active Pennsylvania Registered Nurse (RN) license required.
  • Previous experience in Utilization Management, Care Management, Case Management, or Prior Authorization.
  • Strong understanding of medical necessity review, healthcare regulations, and evidence-based clinical criteria.
  • Experience utilizing InterQual or similar medical necessity guidelines strongly preferred.
  • Excellent critical thinking, clinical assessment, communication, and documentation skills.
  • Ability to independently prioritize a high-volume workload while meeting regulatory turnaround times.


Preferred Experience

  • Managed care, health plan, or payer experience.
  • Experience reviewing inpatient, outpatient, or specialty service authorizations.


This is an excellent opportunity for an experienced RN who enjoys combining clinical expertise with analytical decision-making to ensure members receive timely, appropriate, and high-quality care while supporting organizational quality and compliance

initiatives.

Apply