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Utilization Management Jobs (NOW HIRING)

Imedica

Supervisor, Utilization Management

Madison, WI · On-site

The Utilization Management Supervisor will possess a strong working knowledge of Medicare and Medicaid regulations, mandates, and compliance standards. The supervisor will support the manager and ...

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$39K

$89.5K

$163K

How much do utilization management jobs pay per year?

As of Aug 8, 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 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 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.

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 August 2026, with employment types broken down into 83% Full Time, 13% Part Time, 1% Temporary, and 3% 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 Clinical

BUTTE HOME HEALTH INC

Chico, CA

$50 - $60/hr

Full-time

Posted 22 days ago

Job description

The Utilization Manager, Registered Nurse, is an office-based nursing position responsible for supporting high-quality patient care through clinical oversight, utilization management, and real-time guidance to field clinicians. This role serves as a key clinical resource within the organization, assisting with nursing calls, care coordination, and clinical decision-making to promote positive patient outcomes while ensuring regulatory and payer compliance.

Key responsibilities include:

  • Provide clinical support and guidance to field clinicians, including RNs, LVNs, and therapy staff.

  • Take and triage nursing calls from clinicians, patients, and caregivers as appropriate.

  • Collaborate with field staff to assist with clinical problem-solving, patient status changes, and care planning.

  • Review plans of care and clinical documentation to ensure appropriate utilization of services and skilled need.

  • Monitor visit frequencies and service utilization in alignment with physician orders, payer guidelines, and agency standards.

  • Support case managers with recertifications, discharges, transitions of care, and care coordination.

  • Participate in interdisciplinary collaboration to promote continuity of care and effective communication.

  • Identify clinical risks or concerns and escalate issues appropriately.

  • Support compliance with Medicare Conditions of Participation, regulatory requirements, and agency policies.

  • Contribute to quality improvement initiatives focused on patient outcomes, documentation accuracy, and clinical best practices.

Required Qualifications

  • Active Registered Nurse (RN) license in the state of California.

  • Strong clinical assessment, critical-thinking, and decision-making skills.

  • Excellent verbal and written communication skills.

  • Ability to work collaboratively with interdisciplinary teams.

  • Proficiency with electronic medical records (EMR) systems and basic computer applications.

Preferred Qualifications

  • Experience in utilization management, case management, or clinical coordination.

  • Home Health experience preferred but not required.

  • Knowledge of Medicare home health regulations, payer guidelines, and Conditions of Participation.

  • Experience providing clinical support, education, or mentorship to field clinicians.

  • Strong organizational skills with the ability to manage multiple priorities in a fast-paced office environment.

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