The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria ...
Inform member and provider of Utilization Management determinations and treatment alternatives. * Identifies utilization trends and potential member needs by means of generating reports of encounter ...
Inform member and provider of Utilization Management determinations and treatment alternatives. * Identifies utilization trends and potential member needs by means of generating reports of encounter ...
Utilization Management (UM) Clinical Team Lead (RN, LPN or PT)
Manhattan, NY · Hybrid
$124K - $124K/yr
Inform member and provider of Utilization Management determinations and treatment alternatives. * Identifies utilization trends and potential member needs by means of generating reports of encounter ...
Utilization Management (UM) Clinical Team Lead (RN, LPN or PT)
Manhattan, NY · Hybrid
$124K - $124K/yr
Inform member and provider of Utilization Management determinations and treatment alternatives. * Identifies utilization trends and potential member needs by means of generating reports of encounter ...
Utilization Management (UM) Clinical Team Lead (RN, LPN or PT)
Manhattan, NY · On-site
$124K - $124K/yr
Inform member and provider of Utilization Management determinations and treatment alternatives. * Identifies utilization trends and potential member needs by means of generating reports of encounter ...
Utilization Management (UM) Clinical Team Lead (RN, LPN or PT)
Manhattan, NY · On-site
$124K - $124K/yr
Inform member and provider of Utilization Management determinations and treatment alternatives. * Identifies utilization trends and potential member needs by means of generating reports of encounter ...
Utilization Management - Medical Director
New York, NY · On-site
$200K - $225K/yr
Serve as the physician leader and clinical resource for Utilization Management operations. * Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations. * Partner with ...
Utilization Management - Medical Director
New York, NY · On-site
$200K - $225K/yr
Serve as the physician leader and clinical resource for Utilization Management operations. * Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations. * Partner with ...
Utilization Management - Medical Director
New York, NY · On-site
$200K - $225K/yr
Serve as the physician leader and clinical resource for Utilization Management operations. * Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations. * Partner with ...
Utilization Management - Medical Director
New York, NY · On-site
$200K - $225K/yr
Serve as the physician leader and clinical resource for Utilization Management operations. * Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations. * Partner with ...
Utilization Management
Nyack, NY · On-site
At HealthCare Support, we specialize in offering healthcare professionals a seamless, red-carpet experience throughout their travel journey. Whether you're a nurse, therapist, or allied health ...
Utilization Management
Nyack, NY · On-site
At HealthCare Support, we specialize in offering healthcare professionals a seamless, red-carpet experience throughout their travel journey. Whether you're a nurse, therapist, or allied health ...
Utilization Management - Medical Director
New York, NY · On-site
$200K - $225K/yr
Serve as the physician leader and clinical resource for Utilization Management operations. * Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations. * Partner with ...
Utilization Management - Medical Director
New York, NY · On-site
$200K - $225K/yr
Serve as the physician leader and clinical resource for Utilization Management operations. * Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations. * Partner with ...
Utilization Management - Medical Director
New York, NY · On-site
$200K - $225K/yr
Serve as the physician leader and clinical resource for Utilization Management operations. * Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations. * Partner with ...
Utilization Management - Medical Director
New York, NY · On-site
$200K - $225K/yr
Serve as the physician leader and clinical resource for Utilization Management operations. * Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations. * Partner with ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiecny of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiecny of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiecny of healthcare services in accordance with established criteria ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiecny of healthcare services in accordance with established criteria ...
The Care Manager, under the direction of the Vice President of Clinical Services, is primarily ... Informs member and provider of Utilization Management determinations and treatment alternatives ...
The Care Manager, under the direction of the Vice President of Clinical Services, is primarily ... Informs member and provider of Utilization Management determinations and treatment alternatives ...
The Care Manager, under the direction of the Vice President of Clinical Services, is primarily ... Informs member and provider of Utilization Management determinations and treatment alternatives ...
The Care Manager, under the direction of the Vice President of Clinical Services, is primarily ... Informs member and provider of Utilization Management determinations and treatment alternatives ...
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced ... Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up ...
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced ... Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up ...
Responsibilities Effectively manage the daily operations, workflow, and supervise clinical and non-clinical staff to provide support for the utilization management, benefits and service coordination ...
Responsibilities Effectively manage the daily operations, workflow, and supervise clinical and non-clinical staff to provide support for the utilization management, benefits and service coordination ...
Utilization Manager information
See New Rochelle, NY salary details
$40.1K - $52.2K
9% of jobs
$61K is the 25th percentile. Wages below this are outliers.
$52.2K - $64.2K
22% of jobs
$64.2K - $76.2K
11% of jobs
The median wage is $83.6K / yr.
$76.2K - $88.2K
14% of jobs
$88.2K - $100.2K
12% of jobs
$107.8K is the 75th percentile. Wages above this are outliers.
$100.2K - $112.3K
13% of jobs
$112.3K - $124.3K
13% of jobs
$124.3K - $136.3K
5% of jobs
$136.3K - $148.3K
2% of jobs
$148.3K - $160.3K
0% of jobs
$160.3K - $172.4K
0% of jobs
$40.1K
$93.7K
$172.4K
How much do utilization manager jobs pay per year?
What are the key skills and qualifications needed to thrive as a utilization manager?
What are some common challenges faced by utilization managers, and how can they be addressed?
What is a utilization manager?
A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.
What is the difference between Utilization Manager vs Utilization Coordinator?
| Aspect | Utilization Manager | Utilization Coordinator |
|---|---|---|
| Certifications | Often requires healthcare or case management certifications | May have similar certifications but less emphasis on management |
| Work Environment | Typically in healthcare organizations, overseeing utilization review processes | Supports daily operations, assisting with case documentation and scheduling |
| Employer & Industry Usage | Common in healthcare, insurance, and managed care companies | Found in similar settings, often working under Utilization Managers |
In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 28 days ago
St. Joseph's Health (New Jersey) rating
7.7
Based on 47 frontline employees who took The Breakroom Quiz
157th of 887 rated healthcare providers
Job description
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and organizational role. The UM RN ensures optimal patient care delivery while supporting compliance, quality outcomes, and effective resource utilization. The role is responsible for the assessment of medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate but ensures that an authorization is obtained from the payer, if required, and that the documentation supports the care delivered in such a way that minimizes risks of denials.
St. Joseph's Health is recognized for the expertise and compassion of its highly skilled and responsive staff. The combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care".
Benefits Eligibility: (Full-time and Part-time Employees-over 20 hours a week)
- Competitive salary*
- Robust benefits with health, dental, Rx and vision plans
- 403b retirement plan options with company match**
- Health & Wellness*
- Non-Profit Health System - eligible for Federal Student Loan Forgiveness
- PTO, and paid holidays
- Tuition reimbursement
- Employee Assistance Program
- LTD : Long Term Disability
- Life Insurance Options
- Onsite Day care Program
*Available for Per Diem Employees and Part-time Employees working under 20 hours per week.
**403b Company Match not applicable for Per Diem Employees and Part-time Employees working under 20 hours per week.
Pay transparency: St. Joseph's Health provides a salary range to comply with New Jersey Law. The rate of pay for each position will be determined based on a variety of factors including the candidate's relevant experience, qualifications, skills, etc." The salary range does not include incentives, differential pay or other forms of compensation.
St. Joseph's University Medical Center is an academic tertiary care medical center and state designated trauma center, located on the Paterson campus, regularly accepts referrals of difficult or unusual cases from other hospitals and physicians and performs both complex and routine procedures.
The Medical Center offers a full complement of specialty and subspecialty services including ambulatory, behavioral health, cardiovascular, emergency/trauma, internal medicine, neuroscience, oncology, orthopedic/spine, rehabilitation, surgical specialty, women's health, imaging and pediatrics.
The nursing team at St. Joseph's University Medical Center, which includes St. Joseph's Children's Hospital, has held the Magnet Award for Nursing Excellence, the profession's highest honor, since 1999. They are also recipients of the prestigious 2010 Magnet Prize - one of only 8 Magnet-designated hospitals to ever receive The Magnet Prize, and the only one worldwide to receive the 2010 award.
Work requires the knowledge of theories, principles, and concepts normally acquired through completion of a Bachelor of Science in Nursing and least at least 3 years of previous nursing experience. Preferred 3+ years of Utilization Review or Case Management experience. Case Management Society of America Certification CCM preferred. Licensure required as a Registered Nurse by the State of New Jersey
What St. Joseph's Health (New Jersey) employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom