Utilization Management Specialist Jobs
Utilization Management Specialist jobs are open across health insurance, managed care, hospital systems, and behavioral health organizations, at levels from entry-level reviewer to senior and lead, with specializations in medical necessity review, prior authorization, and case coordination. Find a role that fits from the openings below and apply directly.
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Showing 5 of 180+ Utilization Management Specialist jobs
Description
Care Manager RN - REMOTE position. This position is Per Diem and will work 8- hour, Day shifts.
The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside payers. Activities will be patient-focused, uniform, compliant, and support steadfast advocacy for reimbursement of services provided to patients served within the PH&S ministries.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
Associate's Degree in Nursing.
Upon hire: California Registered Nurse License
4 years Direct patient care experience in an acute hospital setting.
4 years Experience as a case manager in an acute hospital setting.
Preferred Qualifications:
Bachelor’s Degree in Nursing or,
Master's Degree in Nursing.
Upon hire: Case management certification
Experience working with denials and appeals in/for an acute care setting.
Experience in a multi-hospital and/or integrated healthcare system.
Familiarity with Revenue Cycle processes.
Working knowledge of regulations and provider contracts governing coverage of inpatient services (e.g., Medicare, Medi-Cal, Commercial Payers).
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Requsition ID: 457421
Company: Providence Jobs
Job Category: Care Management
Job Function: Clinical Care
Job Schedule: Per-Diem
Job Shift: Day
Career Track: Nursing
Department: 7000 UTILIZATION MGMT CA SOCAL
Address: CA Torrance 21311 Madrona Ave
Work Location: PMI Madrona-Torrance
Workplace Type: Remote
Pay Range: $57.28 - $88.92
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Description
Care Manager RN - REMOTE position. This position is Per Diem and will work 8- hour, Day shifts.
The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside payers. Activities will be patient-focused, uniform, compliant, and support steadfast advocacy for reimbursement of services provided to patients served within the PH&S ministries.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
Associate's Degree in Nursing.
Upon hire: California Registered Nurse License
4 years Direct patient care experience in an acute hospital setting.
4 years Experience as a case manager in an acute hospital setting.
Preferred Qualifications:
Bachelor’s Degree in Nursing or,
Master's Degree in Nursing.
Upon hire: Case management certification
Experience working with denials and appeals in/for an acute care setting.
Experience in a multi-hospital and/or integrated healthcare system.
Familiarity with Revenue Cycle processes.
Working knowledge of regulations and provider contracts governing coverage of inpatient services (e.g., Medicare, Medi-Cal, Commercial Payers).
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Requsition ID: 457421
Company: Providence Jobs
Job Category: Care Management
Job Function: Clinical Care
Job Schedule: Per-Diem
Job Shift: Day
Career Track: Nursing
Department: 7000 UTILIZATION MGMT CA SOCAL
Address: CA Torrance 21311 Madrona Ave
Work Location: PMI Madrona-Torrance
Workplace Type: Remote
Pay Range: $57.28 - $88.92
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Utilization Management Specialist Jobs by Experience Level
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Find JobsUtilization Management Specialist Job Market
Who's Hiring
Top Industries Hiring
- Healthcare & Medical Services15
- Insurance5
- Technology & Software4
- Manufacturing1
What Employers Look For
The qualifications that appear most often in utilization management specialist jobs.
- Active RN, LPN, or clinical licensure required by most employers
- Experience applying InterQual or Milliman medical necessity criteria
- Prior authorization or utilization review experience in a managed care setting
- Proficiency with electronic health records and payer-specific care management platforms
- Knowledge of Medicare, Medicaid, and commercial insurance coverage guidelines
- Certified Case Manager (CCM) or equivalent credential preferred or required
Tips for Your Utilization Management Specialist Job Search
Tailor your resume to criteria language
Hiring managers in utilization management screen for terms like 'medical necessity criteria,' 'InterQual,' and 'Milliman.' Pull the exact language from each job posting and mirror it in your resume's work history and skills sections.
Highlight your clinical background strategically
If you hold an RN, LPN, or other clinical license, list it prominently near your name. Many UM roles require active licensure, and recruiters filter on this before reading anything else on your application.
Target payers, not just providers
Health insurance companies and managed care organizations post far more utilization management specialist openings than hospitals do. Broaden your search beyond hospital careers pages and focus on payer career portals and managed care networks.
Apply early to roles that fit
Migrate Mate lists utilization management specialist openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Prepare for criteria-based scenario questions
Interviewers typically present a clinical vignette and ask how you would apply medical necessity criteria to approve or deny a service. Practice walking through a case using InterQual or Milliman logic out loud before your interview.
Negotiate using your certification status
A CCM or ACM credential, or documented experience with a major criteria set, gives you a concrete negotiating point during offer conversations. Reference it specifically when discussing compensation rather than making a general experience argument.
Utilization Management Specialist Jobs: Frequently Asked Questions
Which companies are hiring the most utilization management specialists?
The companies hiring the most utilization management specialists right now include CVS Health, CommunityCare, and CHRISTUS Health, with the largest share of openings in California, Florida, and Pennsylvania, based on current listings on Migrate Mate as of September 2026. Health insurers and managed care organizations consistently account for the largest volume of postings.
How many utilization management specialist jobs are remote?
About 74% of utilization management specialist openings are fully remote or hybrid as of September 2026, making it one of the more remote-friendly clinical roles available. Prior authorization and medical necessity review functions tend to be the most commonly offered as fully remote positions, while concurrent review roles that require facility coordination are more often on-site or hybrid.
How do you become a utilization management specialist?
Most utilization management specialists start by earning an active clinical license, most commonly as a registered nurse, then gaining direct patient care experience in a hospital, home health, or managed care setting. From there, you build familiarity with medical necessity criteria sets like InterQual or Milliman, either on the job or through self-study. Pursuing a certification such as the Certified Case Manager credential strengthens your candidacy for senior roles.
Can I get a utilization management specialist job with limited experience?
Yes, some entry-level utilization review positions are open to candidates with a clinical license and limited direct UM experience, particularly at regional health plans and third-party administrators. Emphasize any exposure to care coordination, discharge planning, or insurance authorization in your current or previous role. Completing a criteria-set training course before applying, and noting it on your resume, can close the gap when your UM-specific background is thin.
What does the utilization management specialist interview process look like?
Most utilization management interviews include a phone screen with HR or a recruiter, followed by one or two structured interviews with a UM director or clinical supervisor. Expect at least one clinical scenario question where you walk through how you would apply medical necessity criteria to a case. Some employers also include a short written or verbal exercise involving a sample authorization request, particularly for roles that handle complex medical or behavioral health cases.
Where can I find and apply to utilization management specialist jobs?
You can find and apply to utilization management specialist jobs on Migrate Mate, which lists current openings from employers across the United States in one place. Find the roles that match your clinical background and target setting, then apply directly to each listing that fits.
See All 180+ Utilization Management Specialist Jobs
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