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Utilization Management Jobs in Philadelphia, 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.

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All JobsUtilization Management JobsUtilization Management Jobs in Philadelphia, PA

Utilization Management information

See Philadelphia, PA salary details

$39.4K

$90.3K

$164.5K

How much do utilization management jobs pay per year?

As of Sep 5, 2026, the average yearly pay for utilization management in Philadelphia, PA is $90,296.00, according to ZipRecruiter salary data. Most workers in this role earn between $65,100.00 and $105,400.00 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 the most commonly searched types of Utilization Management jobs in Philadelphia, PA?

The most popular types of Utilization Management jobs in Philadelphia, PA are:

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

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

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

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

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

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

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Philadelphia, PA as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, and 2% Contract. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $90,296 per year, or $43.4 per hour.

Utilization Management Supervisor

ProgenyHealth LLC

Plymouth Meeting, PA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New

Job description

Description:


Job Role

The Utilization Management Supervisor will primarily be responsible for managing the UM nursing staff in the day to day operations of the department. This includes oversight and adjustment of work queues, when needed, to maintain work flow balance; monitoring and implementing adherence to department and company metrics; training of new hires and on-going clinical; and various other responsibilities to support the clinical nursing staff and the company program. The incumbent will also be responsible for assessment of the UM program for opportunities to improve efficiencies and/or improve outcomes.


Reporting to the Director of Utilization Management, the Supervisor will work closely with the management staff and will play a key role in implementing the culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission statement: To improve the health outcomes of infants in intensive care nurseries through partnership, care facilitation, continuous quality improvement and a firm commitment to excellence.

Requirements:


Qualifications

  • Registered Nurse (RN) with a current, unrestricted license is required.
  • Two or more years of experience in Managed Care, in a Utilization Review or Case Management role, is required.
  • Experience in a team lead or supervisory role managing nursing staff is desired.
  • Three or more years of clinical experience as a bedside nurse in NICU/PICU/Peds/ICU required.
  • Must be available to stay late as needed to manage staff and caseloads.
  • Experience with URAC standards preferred.
  • Must have demonstrated strong problem-solving skills.
  • Must have proven track record of utilizing tact, diplomacy and strategic thinking in addressing issues and changes in company policy, etc.
  • Must be self-motivated and willing to learn multiple tasks.
  • Must be well organized and able to prioritize tasks.
  • Must have good computer skills and be familiar with using Microsoft Office (Word, Outlook etc)
  • Must demonstrate accuracy in spelling and documentation.
  • Must have commitment to excellence in customer service.


Benefits


Some of the benefits we offer our team are:

  • Paid Time Off
  • Paid Parental Leave
  • Medical, dental, vision benefits
  • 401K with company match
  • Short- and Long-Term Disability
  • Group Life Insurance
  • Tuition reimbursement
  • Professional development opportunities
  • Business Casual work environment
ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: careers@progenyhealth.com


All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.