Mid Level Utilization Management Nurse Jobs
Mid level utilization management nurse jobs go to nurses ready to own case review workflows, guide less experienced peers, and make coverage determinations with minimal oversight. Openings run across Healthcare & Medical Services, Insurance, and Education, with 57% remote or hybrid availability and employers like CHRISTUS Health, Memorial Healthcare System, and Optum hiring at this level now.
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Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.
As the Regional Manager of Utilization Management for Cleveland Clinic Florida, including Indian River, Martin Health, and Weston Hospitals, you will oversee the daily operations of Utilization Management across the region. In this role, you will manage concurrent and retrospective reviews for medical necessity, collaborate with interdisciplinary healthcare teams, monitor utilization outcomes, and lead performance improvement initiatives. You will provide leadership and oversight to Utilization Specialists while ensuring compliance with nationally recognized screening criteria, regulatory requirements, and evolving reimbursement trends. Working closely with Utilization Management Physician Advisors and regional leadership, you will identify opportunities to enhance operational effectiveness, patient outcomes, and resource utilization through the development and implementation of strategic projects and process improvements.
A caregiver in this role works remotely from 8:00 a.m. - 4:30 p.m. with weekend and holiday coverage requirements and occasional travel to Cleveland Clinic sites for meetings.
To be considered for this position, caregivers must reside within one hour of a Cleveland Clinic hospital in Ohio or Florida.
A caregiver who excels in this role will:
For the Florida region –CC Indian River, CC Martin North, CC Martin South, CC Tradition and CC Weston Hospitals:
Manage the daily operations of Utilization Management, which includes concurrent and retrospective utilization review for medical necessity, collaboration and participation with the health care delivery team, review of utilization outcomes and related improvement activities.
Participate in departmental cost budgets and cost containment efforts.
Review and interpret patient population specific financial reports.
Recommend/implement resource utilization.
Prioritize and organize work to meet changing priorities.
Assist Senior Director as needed.
Oversee UM Specialists work load and projects.
Work independently to resolve issues within Utilization Management.
Utilize independent judgment to identify opportunities for improvement and coordinate projects to attain goals.
Provide direction and oversight for the UM Specialists daily activities and complete performance evaluations annually.
Hire and implement disciplinary action when needed.
Solve complex issues within Utilization Management and report results effectively using evidence-based practice framework.
Develop, recommend and initiate corrective action to avoid denials.
Analyze complex data sets to improve patient quality care/ financial outcomes.
Other duties as assigned.
Minimum qualifications for the ideal future caregiver include:
Bachelor's degree in Nursing, Healthcare Administration or Business Administration
Completion of an accredited Registered Nursing RN Program
Proficiency with standard office equipment, including copiers, fax machines, personal computers, as well as Microsoft Office and clinical and financial computer systems
Three years of nursing clinical experience
Two years of recent Utilization Review/Care Management experience
One year of healthcare management experience
Current valid license in the State of Florida as a Registered Nurse (RN)
Basic Life Support (BLS) through American Heart Association (AHA) or American Red Cross
Working knowledge of multiple clinical areas, financial and data analysis, reimbursement practices, preadmission and concurrent review practices
Advanced understanding of payer issues
Experience with licensing and accreditation standards, regulatory standards, Utilization Review methodology and theory
Knowledge of multiple data base systems; clinical, financial and registration
Advanced knowledge of information, data, and project management
Advanced knowledge of unit operations, performance improvement/utilization management, regulatory and professional standards, evidence-based practice patient safety/risk management, and outcomes management
Strong clinical nursing experience and clinical judgment
Preferred qualifications for the ideal future caregiver include:
Master's degree
Demonstrated experience in Project Management, Change Management and/or Program Development
Certified Professional in Utilization Review or Certified Case Manager
Two years of prior leadership experience in Utilization Management
Knowledge of appeals and denial management
Knowledge of medical necessities criteria
Physical Requirements:
Requires walking, standing, and sitting for long periods of time.
Requires constant attention to detail, reading of medical records, and meeting deadlines.
Works in an environment where there is some discomfort due to dust, noise, temperature.
Personal Protective Equipment:
Follows Standard Precautions using personal protective equipment.
Pay Range
Minimum Annual Salary: $76,540.00
Maximum Annual Salary: $116,747.50
The pay range displayed on this job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set and education. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic’s benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.).
Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.
As the Regional Manager of Utilization Management for Cleveland Clinic Florida, including Indian River, Martin Health, and Weston Hospitals, you will oversee the daily operations of Utilization Management across the region. In this role, you will manage concurrent and retrospective reviews for medical necessity, collaborate with interdisciplinary healthcare teams, monitor utilization outcomes, and lead performance improvement initiatives. You will provide leadership and oversight to Utilization Specialists while ensuring compliance with nationally recognized screening criteria, regulatory requirements, and evolving reimbursement trends. Working closely with Utilization Management Physician Advisors and regional leadership, you will identify opportunities to enhance operational effectiveness, patient outcomes, and resource utilization through the development and implementation of strategic projects and process improvements.
A caregiver in this role works remotely from 8:00 a.m. - 4:30 p.m. with weekend and holiday coverage requirements and occasional travel to Cleveland Clinic sites for meetings.
To be considered for this position, caregivers must reside within one hour of a Cleveland Clinic hospital in Ohio or Florida.
A caregiver who excels in this role will:
For the Florida region –CC Indian River, CC Martin North, CC Martin South, CC Tradition and CC Weston Hospitals:
Manage the daily operations of Utilization Management, which includes concurrent and retrospective utilization review for medical necessity, collaboration and participation with the health care delivery team, review of utilization outcomes and related improvement activities.
Participate in departmental cost budgets and cost containment efforts.
Review and interpret patient population specific financial reports.
Recommend/implement resource utilization.
Prioritize and organize work to meet changing priorities.
Assist Senior Director as needed.
Oversee UM Specialists work load and projects.
Work independently to resolve issues within Utilization Management.
Utilize independent judgment to identify opportunities for improvement and coordinate projects to attain goals.
Provide direction and oversight for the UM Specialists daily activities and complete performance evaluations annually.
Hire and implement disciplinary action when needed.
Solve complex issues within Utilization Management and report results effectively using evidence-based practice framework.
Develop, recommend and initiate corrective action to avoid denials.
Analyze complex data sets to improve patient quality care/ financial outcomes.
Other duties as assigned.
Minimum qualifications for the ideal future caregiver include:
Bachelor's degree in Nursing, Healthcare Administration or Business Administration
Completion of an accredited Registered Nursing RN Program
Proficiency with standard office equipment, including copiers, fax machines, personal computers, as well as Microsoft Office and clinical and financial computer systems
Three years of nursing clinical experience
Two years of recent Utilization Review/Care Management experience
One year of healthcare management experience
Current valid license in the State of Florida as a Registered Nurse (RN)
Basic Life Support (BLS) through American Heart Association (AHA) or American Red Cross
Working knowledge of multiple clinical areas, financial and data analysis, reimbursement practices, preadmission and concurrent review practices
Advanced understanding of payer issues
Experience with licensing and accreditation standards, regulatory standards, Utilization Review methodology and theory
Knowledge of multiple data base systems; clinical, financial and registration
Advanced knowledge of information, data, and project management
Advanced knowledge of unit operations, performance improvement/utilization management, regulatory and professional standards, evidence-based practice patient safety/risk management, and outcomes management
Strong clinical nursing experience and clinical judgment
Preferred qualifications for the ideal future caregiver include:
Master's degree
Demonstrated experience in Project Management, Change Management and/or Program Development
Certified Professional in Utilization Review or Certified Case Manager
Two years of prior leadership experience in Utilization Management
Knowledge of appeals and denial management
Knowledge of medical necessities criteria
Physical Requirements:
Requires walking, standing, and sitting for long periods of time.
Requires constant attention to detail, reading of medical records, and meeting deadlines.
Works in an environment where there is some discomfort due to dust, noise, temperature.
Personal Protective Equipment:
Follows Standard Precautions using personal protective equipment.
Pay Range
Minimum Annual Salary: $76,540.00
Maximum Annual Salary: $116,747.50
The pay range displayed on this job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set and education. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic’s benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.).
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Find JobsMid Level Utilization Management Nurse Job Market
Who's Hiring
- CHRISTUS Health3
- Memorial Healthcare System3
- Optum2
- UF Health2
- Alignment Healthcare2
Top Industries Hiring
- Healthcare & Medical Services41
- Insurance9
- Education3
- Manufacturing1
- Technology & Software1
Mid Level Utilization Management Nurse Jobs: Frequently Asked Questions
How do I get a mid level utilization management nurse job?
Position yourself around clinical decision-making and independent case management. Highlight experience conducting prior authorization reviews, applying InterQual or Milliman criteria, and coordinating with multidisciplinary teams. Emphasize situations where you owned a caseload or process without heavy supervision. Certifications like the Certified Case Manager credential strengthen applications, and demonstrating measurable outcomes from your reviews will set you apart from candidates who list only duties.
Which companies hire mid level utilization management nurses?
Companies hiring mid level utilization management nurses right now include CHRISTUS Health, Memorial Healthcare System, and Optum, based on current listings on Migrate Mate as of July 2026. Hiring at this level is concentrated among managed care organizations, health insurance plans, and large hospital systems building out their care management and cost-containment functions.
Are there remote mid level utilization management nurse jobs?
Yes, and utilization management is one of the more remote-accessible nursing specialties given its chart-based and telephonic nature. About 57% of mid level utilization management nurse openings are remote or hybrid as of July 2026, making it a strong option for nurses seeking flexibility without stepping away from clinical decision-making work.
How do I move up to a mid level utilization management nurse role?
The path into mid level typically runs through bedside or case management experience where you build comfort reading clinical documentation and applying medical necessity criteria. Over time, taking on more complex cases, seeking exposure to payer-side reviews, and earning a certification in case management or utilization review signals readiness. Demonstrating ownership of outcomes rather than just completing tasks is what separates mid level candidates from entry-level applicants.
Which industries hire the most mid level utilization management nurses?
Mid Level utilization management nurse roles concentrate in Healthcare & Medical Services, Insurance, and Education, based on current listings on Migrate Mate as of July 2026. These sectors drive demand because they carry the greatest need for clinical review functions that control costs, meet regulatory requirements, and ensure appropriate levels of care across large member or patient populations.