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