Mid Level Utilization Management Specialist Jobs
Mid level utilization management specialist jobs go to clinicians and analysts ready to own case review workflows, apply independent clinical judgment, and guide teams through complex authorization decisions without constant oversight. Hiring runs across Healthcare & Medical Services, Insurance, and Education, with a strong mix of remote and on-site positions, and employers like CHRISTUS Health, Memorial Healthcare System, and Optum competing for utilization management specialists at this level now.
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Showing 5 of 67+ Mid Level Utilization Management Specialist jobs
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 Specialist 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 Specialist Jobs: Frequently Asked Questions
How do I get a mid level utilization management specialist job?
Position your experience around independent clinical decision-making, not just task completion. Highlight specific authorization workflows you have owned, criteria sets you have applied such as InterQual or Milliman, and any measurable outcomes you have driven, like denial reduction or turnaround improvement. Tailoring your resume to reflect scope of ownership, rather than a list of duties, is what separates mid level candidates from early-career applicants in this field.
Which companies hire mid level utilization management specialists?
Companies hiring mid level utilization management specialists right now include CHRISTUS Health, Memorial Healthcare System, and Optum, based on current listings on Migrate Mate as of July 2026. Health insurers, managed care organizations, and large hospital systems drive the most consistent hiring at this level, often seeking candidates who can work across multiple lines of business or care settings with limited supervision.
Are there remote mid level utilization management specialist jobs?
Yes, and the share is substantial for this role. About 57% of mid level utilization management specialist openings are remote or hybrid as of July 2026, reflecting how much of this work, including chart reviews, authorization determinations, and payer communication, can be performed entirely outside a clinical facility. Fully remote roles typically require reliable internet access and familiarity with care management platforms.
How do I move up to a mid level utilization management specialist role?
Getting to mid level means building depth in clinical criteria application, showing you can manage a caseload independently, and producing outcomes your team can point to. Over your first few years, seek exposure to different care settings, learn multiple utilization review criteria systems, and take ownership of quality or audit projects. Demonstrating that you flag issues proactively and influence decisions, rather than just executing instructions, is what earns mid level consideration.
Which industries hire the most mid level utilization management specialists?
Mid Level utilization management specialist 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 utilization management sits at the intersection of clinical care and cost containment, functions that health plans, managed care firms, and integrated delivery networks all need to staff with experienced, decision-ready clinicians rather than entry-level reviewers.