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 14+ Utilization Management Specialist jobs
Penn State Health - Hershey Medical Center
Location: US:PA: Hershey
Work Type: Full Time
FTE: 1.00
Shift: Day
Hours: 8:00a - 4:30p
Recruiter Contact: Denisse M. Rosado at drosado1@pennstatehealth.psu.edu
SUMMARY OF POSITION:
Responsible for the review of clinical documentation in the Electronic Medical Record (EMR), comparing it to the nationally accepted and evidence-based criteria to certify an admission to the facility, and for concurrent/continued stay review as appropriate. Also responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management.
MINIMUM QUALIFICATION(S):
- Bachelor's Degree in Nursing or Master's Degree in Nursing required
- 3 years of advanced clinical experience in a hospital setting required
- Currently licensed to practice as a Registered Nurse by the state of employment or holds a multistate RN license through the Interstate Nurse Licensure Compact
- Demonstrated ability to problem-solve complex, multidimensional situations required
- Ability to successfully manage conflict and negotiate "win-win" solutions required
- Strong organizational, task prioritization, and delegation skills required
- Strong oral and written communication skills required
- Ability to work independently required
PREFERRED QUALIFICATION(S):
- Financial Counseling experience preferred
WHY PENN STATE HEALTH?
Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population, and the ability to provide individualized, innovative, and specialized care to patients in the community.
Penn State Health offers an exceptional benefits package including medical, dental and vision with no waiting period as well as a Total Rewards Program that highlights a few of the many additional offerings below:
- Be Well with Employee Wellness Programs, and Fitness Discounts (University Fitness Center, Peloton)
- Be Balanced with Generous Paid Time Off, Personal Time, and Paid Parental Leave
- Be Secured with Retirement, Extended Illness Bank, Life Insurance, and Identity Theft Protection
- Be Rewarded with Competitive Pay, Tuition Reimbursement, and PAWS UP employee recognition program
- Be Supported by the HR Solution Center, Learning and Organizational Development and Virtual Benefits Orientation, Employee Exclusive Concierge Service for scheduling
WHY PENN STATE HEALTH MILTON HERSHEY MEDICAL CENTER?
Penn State Hershey Medical Center is Central Pennsylvania’s only Academic Medical Center, Level 1 Regional Adult and Pediatric Trauma Center, and Tertiary Care Provider. As a four-time Magnet-designated hospital, Hershey Medical Center values the hard work and dedication that our employees exhibit every day. Through our core values of Respect, Integrity, Teamwork, and Excellence, our employees are a team committed to compassionate care for our diverse patient population, our community and each other. As a valued team member, we promote continued professional development, specialty certification, continuing education, and career growth.
YOU TAKE CARE OF THEM. WE’LL TAKE CARE OF YOU. State-of-the-art equipment, endless learning, and a culture of excellence – that’s Penn State Health. But what makes our healthcare award-winning? That’s all you.
This job posting is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. Eligibility for shift differential pay based on the terms outlined in company policy or union contract. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.
Penn State Health is an Equal Opportunity Employer and does not discriminate on the basis of any protected class including disability or veteran status. Penn State Health’s policies and objectives are in direct compliance with all federal and state constitutional provisions, laws, regulations, guidelines, and executive orders that prohibit or outlaw discrimination.
Union: SEIU Healthcare Pennsylvania
Penn State Health - Hershey Medical Center
Location: US:PA: Hershey
Work Type: Full Time
FTE: 1.00
Shift: Day
Hours: 8:00a - 4:30p
Recruiter Contact: Denisse M. Rosado at drosado1@pennstatehealth.psu.edu
SUMMARY OF POSITION:
Responsible for the review of clinical documentation in the Electronic Medical Record (EMR), comparing it to the nationally accepted and evidence-based criteria to certify an admission to the facility, and for concurrent/continued stay review as appropriate. Also responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management.
MINIMUM QUALIFICATION(S):
- Bachelor's Degree in Nursing or Master's Degree in Nursing required
- 3 years of advanced clinical experience in a hospital setting required
- Currently licensed to practice as a Registered Nurse by the state of employment or holds a multistate RN license through the Interstate Nurse Licensure Compact
- Demonstrated ability to problem-solve complex, multidimensional situations required
- Ability to successfully manage conflict and negotiate "win-win" solutions required
- Strong organizational, task prioritization, and delegation skills required
- Strong oral and written communication skills required
- Ability to work independently required
PREFERRED QUALIFICATION(S):
- Financial Counseling experience preferred
WHY PENN STATE HEALTH?
Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population, and the ability to provide individualized, innovative, and specialized care to patients in the community.
Penn State Health offers an exceptional benefits package including medical, dental and vision with no waiting period as well as a Total Rewards Program that highlights a few of the many additional offerings below:
- Be Well with Employee Wellness Programs, and Fitness Discounts (University Fitness Center, Peloton)
- Be Balanced with Generous Paid Time Off, Personal Time, and Paid Parental Leave
- Be Secured with Retirement, Extended Illness Bank, Life Insurance, and Identity Theft Protection
- Be Rewarded with Competitive Pay, Tuition Reimbursement, and PAWS UP employee recognition program
- Be Supported by the HR Solution Center, Learning and Organizational Development and Virtual Benefits Orientation, Employee Exclusive Concierge Service for scheduling
WHY PENN STATE HEALTH MILTON HERSHEY MEDICAL CENTER?
Penn State Hershey Medical Center is Central Pennsylvania’s only Academic Medical Center, Level 1 Regional Adult and Pediatric Trauma Center, and Tertiary Care Provider. As a four-time Magnet-designated hospital, Hershey Medical Center values the hard work and dedication that our employees exhibit every day. Through our core values of Respect, Integrity, Teamwork, and Excellence, our employees are a team committed to compassionate care for our diverse patient population, our community and each other. As a valued team member, we promote continued professional development, specialty certification, continuing education, and career growth.
YOU TAKE CARE OF THEM. WE’LL TAKE CARE OF YOU. State-of-the-art equipment, endless learning, and a culture of excellence – that’s Penn State Health. But what makes our healthcare award-winning? That’s all you.
This job posting is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. Eligibility for shift differential pay based on the terms outlined in company policy or union contract. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.
Penn State Health is an Equal Opportunity Employer and does not discriminate on the basis of any protected class including disability or veteran status. Penn State Health’s policies and objectives are in direct compliance with all federal and state constitutional provisions, laws, regulations, guidelines, and executive orders that prohibit or outlaw discrimination.
Union: SEIU Healthcare Pennsylvania
See All Utilization Management Specialist Jobs
Jump back to the full list of openings and apply to any utilization management specialist role that fits.
Find JobsUtilization Management Specialist Job Market
A snapshot from current openings nationwide, updated as new roles post.
Who's Hiring
- Memorial Healthcare System3
- Albany Medical Center1
- Alignment Healthcare1
- Clover Health1
- Delta Dental of Michigan1
Top Industries Hiring
- Healthcare & Medical Services6
- Insurance5
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 Memorial Healthcare System, Albany Medical Center, and Alignment Healthcare, with the largest share of openings in New York, Florida, and Ohio, based on current listings on Migrate Mate as of June 2026. Health insurers and managed care organizations consistently account for the largest volume of postings.
How many utilization management specialist jobs are remote?
About 57% of utilization management specialist openings are fully remote or hybrid as of June 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 Utilization Management Specialist Jobs
Jump back to the full list of openings and apply to any utilization management specialist role that fits.
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