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Utilization Management Jobs (NOW HIRING)

SIHO Insurance Services, Inc.

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Utilization Management Nurse

Columbus, IN · On-site

Manager of Utilization Management Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization Management (UM) services for SIHO (and ...

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Utilization Management information

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$39K

$89.5K

$163K

How much do utilization management jobs pay per year?

As of Jul 6, 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 June 2026, with employment types broken down into 85% Full Time, and 15% Part Time. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.
Utilization Management Manager-Utilization Mgmt- Days - FT

Utilization Management Manager-Utilization Mgmt- Days - FT

Memorial Health System

Gulfport, MS • On-site

Full-time

Posted 27 days ago

Job description


Oversee the management of patient care utilization, ensuring appropriate healthcare services are provided while optimizing resource use. This individual will be responsible for leading a team of nurses who review medical necessity, appropriateness and efficiency of healthcare services. Ensure compliance with regulatory requirements and maintain high standards of care.
Responsibilities
  • Supervise and lead the UM nursing team and Pre-Certification Specialists, ensuring the review of patient cases for appropriate medical necessity and care protocols
  • Develop, implement and maintain UM policies and procedures in accordance with healthcare regulation and organizational standards
  • Conduct regular training and provide ongoing support for UR team to improve knowledge and performance
  • Collaborate with physicians, other healthcare providers and insurance companies to review and improve treatment plans. Ensure all services are medically necessary and cost effective
  • Evaluate and analyze healthcare utilization trends, identify opportunities for improvement and solutions to improve outcome
  • Monitor and ensure compliance with regulatory requirements including Medicare, Medicaid and other payer policies
  • Prepare and present reports on utilization metrics, case reviews and outcomes to administration leadership groups
  • Resolve complex case issues and provide guidance on challenging utilization decisions
  • Ensure accurate documentation of all UM reviews, ensuring compliance with internal and external audit
  • Foster effective communication between departments, stakeholders and healthcare professionals

Qualifications
Education Requirements
Required: Bachelor Degree
  • Bachelor of Science in Nursing, with an active unrestricted license

Preferred: Master's Degree
  • Nursing or other clinical discipline, Health Administration, Finance, Business Administration, or a related field

License or Certification Requirements
Required: License
  • Nursing degree (RN, BS, BSN, or advanced degree) and unrestricted active nursing license

Experience Requirements
Required: 5 years
  • Nursing experience with at least 2 years in Utilization Management or case management role

Preferred: 2 years
  • Leadership or management experience in nursing or related field

Core Competencies
Knowledge:
  • In depth knowledge of healthcare utilization management processes, medical terminology and clinical guidelines
  • Familiarity with payer requirements and regulation including Medicare, Medicaid and private insurers
  • Working knowledge of applications that are used to enhance utilization management based on evidenced based approach and guidelines
  • Strong knowledge of Microsoft Office applications

Skills:
  • Analytical Skills: The ability to analyze large data sets, determine trends, synthesize results, and deliver prioritized details through effective reporting
  • Communication Skills: Strong communication and interpersonal skills for effective collaboration and education
  • Problem-Solving Skills: The capacity to understand issues, derive many potential solutions, troubleshoot discrepancies, and understand systematic approaches to problem resolution

Abilities:
  • Attention to Detail: Precision is essential when reporting critical analysis to inform decision-making and operational change
  • Time Management: Managing multiple tasks and deadlines while prioritizing work is essential in a fast-paced healthcare environment
  • Technology Proficiency: Beyond EHR systems, familiarity with various billing software and technology tools

Work Environment: This position may involve working in a variety of clinical and administrative settings, requiring adaptability and a proactive approach to problem-solving.
Physical Demands: Frequent reaching, sitting, walking, and standing may be required. No special coordination beyond that used for normal mobility and handling of everyday objects and materials is needed to perform the job.

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