The northern Jiziwan region of the Yellow River basin in China serves as a vital national base for energy and strategic resources, a major grain-producing area, and an ecological security barrier. Promoting the efficient utilization of water resources in this region is a crucial foundation for ensuring ecological protection and high-quality development in the Yellow River basin. In light of the water resource conditions and current water usage in the northern Jiziwan region, this study analyzes the water scarcity problem and the urgency of achieving efficient water use in the region. It summarizes the achievements made in strengthening water resource management and developing water-saving agriculture in the basin in recent years, focusing on aspects including total water resource control, supply-demand balance, regional water networks, and regulatory measures. Furthermore, it proposes the following pathways for the efficient utilization of water resources in the basin from engineering and management perspectives: (1) strictly controlling the expansion of irrigated areas while improving water use efficiency; (2) improving the regional water network system to coordinate multiple water sources and users for scientific allocation; (3) enhancing the intelligent monitoring of water consumption while establishing a precise measurement system for agricultural water use and an evaluation system for water use efficiency; and (4) advancing agricultural water pricing reforms to create a new mechanism for water conservation rewards and subsidies. These measures aim to provide support for water security guarantee, ecological protection, and high-quality development in the Yellow River basin.