Utilization Management Careers

What is Utilization Management?

Utilization Management (UM) involves reviewing requests for medical services to ensure they meet clinical criteria for medical necessity. Physicians in UM apply evidence-based guidelines to authorization decisions.

Key Responsibilities

• Review medical records for authorization requests
• Apply clinical criteria (InterQual, MCG, proprietary)
• Make medical necessity determinations
• Document review rationale
• Identify cases needing physician advisor review

Common Job Titles

• Utilization Review Physician
• Medical Director, Utilization Management
• UM Medical Reviewer
• Clinical Reviewer
• Associate Medical Director

Work Settings

• Health insurance companies
• Hospitals and health systems
• Third-party UM companies
• Accountable Care Organizations

Compensation Range

• Part-time/Per-case: $100-200 per hour
• Full-time UM Physician: $200,000 - $280,000
• Medical Director: $250,000 - $350,000

Pros and Cons

Pros:
- Often remote work available
- Flexible hours (especially part-time)
- Good entry point to insurance industry
- No on-call or weekends typically

Cons:
- Can be repetitive
- Production metrics can be stressful
- May be seen negatively by clinical colleagues