Utilization Review Nurse
Providence, RI · On-site
... 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 ...
Utilization Review Nurse
Providence, RI · On-site
... 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 ...
LPN - Utilization Review Nurse
New Bedford, MA · On-site
$32 - $39/hr
Managed care and utilization management experience; * Able to organize and structure own workload, attention to detail, and ability to maintain up to date tracking and filing systems; * Good clinical ...
LPN - Utilization Review Nurse
New Bedford, MA · On-site
$32 - $39/hr
Managed care and utilization management experience; * Able to organize and structure own workload, attention to detail, and ability to maintain up to date tracking and filing systems; * Good clinical ...
LPN - Utilization Review Nurse
New Bedford, MA · On-site
$32 - $39/hr
Managed care and utilization management experience; * Able to organize and structure own workload, attention to detail, and ability to maintain up to date tracking and filing systems; * Good clinical ...
LPN - Utilization Review Nurse
New Bedford, MA · On-site
$32 - $39/hr
Managed care and utilization management experience; * Able to organize and structure own workload, attention to detail, and ability to maintain up to date tracking and filing systems; * Good clinical ...
LPN - Utilization Review Nurse
New Bedford, MA · On-site
$32 - $39/hr
Managed care and utilization management experience; * Able to organize and structure own workload, attention to detail, and ability to maintain up to date tracking and filing systems; * Good clinical ...
LPN - Utilization Review Nurse
New Bedford, MA · On-site
$32 - $39/hr
Managed care and utilization management experience; * Able to organize and structure own workload, attention to detail, and ability to maintain up to date tracking and filing systems; * Good clinical ...
In depth knowledge of the healthcare (or related) industry, of technology, and of processes, such as cross-functional business processes for major operational areas, project management, vendor ...
In depth knowledge of the healthcare (or related) industry, of technology, and of processes, such as cross-functional business processes for major operational areas, project management, vendor ...
Senior Business Transformation Product Manager - Utilization Management
Providence, RI · On-site +1
$102K - $163K/yr
In depth knowledge of the healthcare (or related) industry, of technology, and of processes, such as cross-functional business processes for major operational areas, project management, vendor ...
Senior Business Transformation Product Manager - Utilization Management
Providence, RI · On-site +1
$102K - $163K/yr
In depth knowledge of the healthcare (or related) industry, of technology, and of processes, such as cross-functional business processes for major operational areas, project management, vendor ...
Must have prior authorization utilization experience. * Managed Care/Medicare experience preferred. Skills: * MUST HAVE MEDCOMPASS or ASSURECARE exp. * MUST HAVE MANAGED CARE exp and Medicare ...
Must have prior authorization utilization experience. * Managed Care/Medicare experience preferred. Skills: * MUST HAVE MEDCOMPASS or ASSURECARE exp. * MUST HAVE MANAGED CARE exp and Medicare ...
Formulary Management Pharmacist
Providence, RI · On-site
$58.75 - $70.75/hr
Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...
Formulary Management Pharmacist
Providence, RI · On-site
$58.75 - $70.75/hr
Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...
Formulary Management Pharmacist
Warwick, RI · On-site
$57 - $68.50/hr
Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...
Formulary Management Pharmacist
Warwick, RI · On-site
$57 - $68.50/hr
Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...
Medical Director - Inpatient Review
Providence, RI · On-site
$223.80 - $313.10/hr
Analyze complex hospital-based cases and deliver clear, well-reasoned utilization management determinations. * Communicate with external providers via phone to obtain clinical information and discuss ...
New
Medical Director - Inpatient Review
Providence, RI · On-site
$223.80 - $313.10/hr
Analyze complex hospital-based cases and deliver clear, well-reasoned utilization management determinations. * Communicate with external providers via phone to obtain clinical information and discuss ...
New
Field Medical Director, Vascular Surgeon
Providence, RI · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Field Medical Director, Vascular Surgeon
Providence, RI · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
Collaborates with utilization management to ensure communication between case management and utilization management teams. Participates in daily observation rounds to collaborate with members of the ...
Collaborates with utilization management to ensure communication between case management and utilization management teams. Participates in daily observation rounds to collaborate with members of the ...
Case Mgt Supv and Observation Patient Coord
Providence, RI · On-site
$90K - $180K/yr
Partners with medical staff, case manager, utilization manager, and other members of the healthcare team in collaboration with the patient/family to facilitate the plan of care for patients who are ...
Case Mgt Supv and Observation Patient Coord
Providence, RI · On-site
$90K - $180K/yr
Partners with medical staff, case manager, utilization manager, and other members of the healthcare team in collaboration with the patient/family to facilitate the plan of care for patients who are ...
Partners with medical staff, case manager, utilization manager, and other members of the healthcare team in collaboration with the patient/family to facilitate the plan of care for patients who are ...
Partners with medical staff, case manager, utilization manager, and other members of the healthcare team in collaboration with the patient/family to facilitate the plan of care for patients who are ...
RN Care Manager
Warwick, RI · On-site
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs utilization and resource management by assessing and reassessing the patients' medical necessity to ...
RN Care Manager
Warwick, RI · On-site
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs utilization and resource management by assessing and reassessing the patients' medical necessity to ...
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs utilization and resource management by assessing and reassessing the patients' medical necessity to ...
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs utilization and resource management by assessing and reassessing the patients' medical necessity to ...
RN Care Manager
Warwick, RI · On-site
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs utilization and resource management by assessing and reassessing the patients' medical necessity to ...
RN Care Manager
Warwick, RI · On-site
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs utilization and resource management by assessing and reassessing the patients' medical necessity to ...
Travel RN Case Manager - $2,706 per week
North Providence, RI · On-site
$2.7K/wk
Supports utilization management and ensures compliance with payer guidelines. Onboarding typically takes 2-4 weeks based on documentation and clearance processes. Requirements Required for Onboarding:
Travel RN Case Manager - $2,706 per week
North Providence, RI · On-site
$2.7K/wk
Supports utilization management and ensures compliance with payer guidelines. Onboarding typically takes 2-4 weeks based on documentation and clearance processes. Requirements Required for Onboarding:
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs utilization and resource management by assessing and reassessing the patients' medical necessity to ...
Duties & Responsibilities 1. Per the hospital Utilization Management Plan, the RN CM performs utilization and resource management by assessing and reassessing the patients' medical necessity to ...
Utilization Management information
See Providence, RI salary details
$39.4K - $50.8K
15% of jobs
$50.8K - $62.2K
8% of jobs
$63.8K is the 25th percentile. Wages below this are outliers.
$62.2K - $73.6K
15% of jobs
The median wage is $80.8K / yr.
$73.6K - $85K
20% of jobs
$85K - $96.3K
11% of jobs
$102K is the 75th percentile. Wages above this are outliers.
$96.3K - $107.7K
13% of jobs
$107.7K - $119.1K
5% of jobs
$119.1K - $130.5K
3% of jobs
$130.5K - $141.9K
4% of jobs
$141.9K - $153.3K
3% of jobs
$153.3K - $164.7K
3% of jobs
$39.4K
$90.4K
$164.7K
How much do utilization management jobs pay per year?
As of Aug 21, 2026, the average yearly pay for utilization management in Providence, RI is $90,397.00, according to ZipRecruiter salary data. Most workers in this role earn between $65,200.00 and $105,600.00 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 Providence, RI?
The most popular types of Utilization Management jobs in Providence, RI are:
What are popular job titles related to Utilization Management jobs in Providence, RI?
For Utilization Management jobs in Providence, RI, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Providence, RI look for?
The top searched job categories for Utilization Management jobs in Providence, RI are:
What cities near Providence, RI are hiring for Utilization Management jobs?
Cities near Providence, RI with the most Utilization Management job openings:
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.
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