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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 ...

UHS

Utilization Management Coordinator

Forest Park, IL · On-site

$30 - $46/hr

We are currently seeking an Utilization Management Coordinator position for Riveredge Hospital. Simply apply to the posting and discuss your interests with the hiring manager if you are selected to ...

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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 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 Coordinator

Utilization Management Coordinator

Independent Living Systems

Miami, FL • On-site

Full-time

Posted 3 days ago

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Utilization Management Coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Utilization Management Coordinator plays an essential role in ensuring that the authorization requests are processed effectively. The Utilization Management Coordinator reviews the prior authorization form received for documentation completeness and determines if the requested service requires an authorization. This role includes inbound and outbound communication with both internal and external customers. Ultimately, the Utilization Management Coordinator contributes to improving member outcomes by facilitating timely access to necessary care.

Minimum Qualifications:

  • High school diploma or equivalent required
  • 2 years of experience as a medical office referral/authorization clerk, office assistant or other medical office experience.
  • Strong knowledge of healthcare regulations, and medical terminology.
  • Relevant experience may substitute for the educational requirement on a year-for-year basis.

Preferred Qualifications:

  • Associate degree in Health Administration, or a related healthcare field
  • Certification in Utilization Review (e.g., Certified Professional in Utilization Review - CPUR) or Case Management (e.g., CCM).
  • Experience working within managed care organizations or health insurance companies.
  • Familiarity with regulatory requirements such as Florida Medicaid/SMMC and CMS guidelines, HIPAA and current health plan accreditation standards,.

Responsibilities:

  • Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
  • Continuously reviews prior authorization requests received via oral, provider portal, fax and/or email to ensure timely processing.
  • Screens prior authorization requests for appropriate referral to the Clinical Care Specialist.
  • Performs non-medical research including eligibility verification, reviewing the prior authorization grid to confirm if services do or do not require prior authorization.
  • Places outbound calls to providers to request clinical information for review.
  • Perform other duties as assigned.

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