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Utilization Management Jobs (NOW HIRING)

Wellpath

Director Utilization Mgmt

Lemoyne, PA · On-site

Overview The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within their assigned ...

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$39K

$89.5K

$163K

How much do utilization management jobs pay per year?

As of Jul 20, 2026, the average yearly pay for utilization management in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

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.

More about Utilization Management jobs
What cities are hiring for Utilization Management jobs? Cities with the most Utilization Management job openings:
What are the most commonly searched types of Utilization Management jobs? The most popular types of Utilization Management jobs are:
What states have the most Utilization Management jobs? States with the most job openings for Utilization Management jobs include:
What job categories do people searching Utilization Management jobs look for? The top searched job categories for Utilization Management jobs are:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.
Utilization Management Nurse

Utilization Management Nurse

Akron Children's Hospital

Akron, OH • On-site, Remote

Full-time

Posted 5 days ago

Akron Children's Hospital rating

7.2

Company rating: 7.2 out of 10

Based on 95 frontline employees who took The Breakroom Quiz

396th of 1,020 rated hospitals

Job description

Full Time Days
7am-4:30pm
40 Hours/Week
Utilization management and pediatric nursing experience preferred
Summary:
The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources and serving as a resource to the hospital staff on utilization management practices.
Responsibilities:
1. Conduct Utilization Review & Determine Appropriate Level of Care
Applies evidence-based medical necessity criteria, validates admission status, and ensures all inpatient, observation, and outpatient-in-a-bed cases meet criteria. Collaborates proactively with physician advisors and attending providers for accurate level-of-care decisions and authorization of hospital days.
2. Manage Denials, Compliance, and Quality Improvement Activities
Participates in denial management and peer review processes, identifies compliance or ethical issues, and contributes to quality and safety initiatives aimed at improving departmental and hospital workflows.
3. Support Care Progression Through Interdisciplinary Collaboration
Actively engages in daily huddles, multidisciplinary rounds, and patient care discussions to understand service intensity, discharge barriers, and progression of care, while serving as a resource to the care team on utilization, documentation, and admission requirements.
4. Maintain Accurate and Timely Documentation
Clearly documents all reviews, interactions, and decisions in Midas, Epic, and other required systems.
5. Performs additional duties as assigned.
Other information:
Technical Expertise
1. Experience in inpatient clinical is required.
2. Experience in pediatrics is preferred.
3. Experience working with all levels within an organization is required.
4. Experience in healthcare is required.
5. Proficiency in MS Office [Outlook, Excel, Word] or similar software is required.
Education and Experience
1.Education: Bachelor's in nursing [BSN] is required. For employees hired after July 1, 2013, BSN is required or must be obtained within 5 years from date of hire.
2. Certification: Registered Nurse licensure is required.
3. Years of relevant experience: 3 years is required.
4. Years of experience supervising: None.
Full Time
FTE: 1.000000
Status: Remote

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About Akron Children's Hospital

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Akron Children's Hospital has been caring for children since 1890, and our pediatric specialties are ranked among the nation's best by U.S. News & World Report. With two hospital campuses, regional health centers and more than 50 primary and specialty care locations throughout Ohio, we're making it easier for today's busy families to find the high-quality care they need. In 2020, our health care system provided more than 1.1 million patient encounters. We also operate neonatal and pediatric units in the hospitals of our regional health care partners. Every year, our Children's Home Care Group nurses provide thousands of in-home visits, and our School Health nurses manage clinic visits for students from preschool through high school. With our Quick Care Online virtual visits and Akron Children's Anywhere app, we're here for families whenever and wherever they need us. Learn more at akronchildrens.org.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Akron, OH, US

Year founded

1890

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