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Director Of Utilization Management Jobs (NOW HIRING)

Acadia Healthcare

Director of Utilization

San Rafael, CA · On-site

$105K - $130K/yr

Direct and manage the day-to-day operations of the Utilization Review department. Responsibilities ESSENTIAL FUNCTIONS: * Monitor utilization of services and optimize reimbursement for the facility ...

Acadia Healthcare

Director of Utilization

El Paso, TX · On-site

Direct and manage the day-to-day operations of the Utilization Review department. Responsibilities ESSENTIAL FUNCTIONS: * Monitor utilization of services and optimize reimbursement for the facility ...

A24Group

Director of Case Management FT

Las Cruces, NM · On-site

Direct the implementation and coordination of utilization management processes to ensure appropriate level of care and resource utilisation * Oversee case management activities across the patient ...

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$18K

$52.3K

$84K

How much do director of utilization management jobs pay per year?

As of Jul 8, 2026, the average yearly pay for director of utilization management in the United States is $52,322.00, according to ZipRecruiter salary data. Most workers in this role earn between $40,000.00 and $60,000.00 per year, depending on experience, location, and employer.

What are some common challenges faced by a Director of Utilization Management and how can they be addressed?

A Director of Utilization Management often navigates challenges such as balancing cost containment with quality patient care, managing interdisciplinary teams, and keeping up with changing healthcare regulations. Successfully addressing these challenges requires strong communication skills, the ability to analyze and implement evidence-based utilization protocols, and fostering a collaborative environment among clinical staff, case managers, and administrative teams. Staying engaged with ongoing education and industry best practices also helps in proactively adapting to regulatory updates and evolving patient needs.

What is the difference between Director Of Utilization Management vs Utilization Review Nurse?

AspectDirector Of Utilization ManagementUtilization Review Nurse
CredentialsTypically requires a nursing license, healthcare management experience, and sometimes a master's degreeRegistered Nurse (RN) license, often with certifications in case management or utilization review
Work EnvironmentAdministrative setting, overseeing utilization management teams and policiesClinical setting, performing patient chart reviews and assessments
Employer & IndustryHospitals, insurance companies, healthcare systemsHospitals, insurance companies, healthcare providers
Primary FocusStrategic oversight of utilization management processes and complianceClinical review of patient cases to determine medical necessity

The main difference is that the Director Of Utilization Management focuses on overseeing and managing utilization strategies at an organizational level, while the Utilization Review Nurse conducts clinical reviews to assess individual patient cases. Both roles require healthcare credentials, but their responsibilities and work environments differ significantly.

What are the key skills and qualifications needed to thrive as a Director of Utilization Management, and why are they important?

To thrive as a Director of Utilization Management, you typically need a strong background in healthcare administration, case management, and managed care principles, often supported by a clinical degree (RN, LCSW, or equivalent) and relevant experience. Familiarity with utilization review software, health information systems, and certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) are highly valued. Leadership, strategic decision-making, and excellent interpersonal skills help drive team performance and facilitate collaboration across departments. These competencies are vital to ensuring effective resource use, regulatory compliance, and high-quality patient outcomes.

What does a Director of Utilization Management do?

A Director of Utilization Management oversees the processes that ensure patients receive appropriate, efficient, and medically necessary care within a healthcare organization. They lead teams that review patient cases, manage resource use, and implement policies to optimize healthcare quality and cost-effectiveness. This role often involves coordinating with physicians, insurance providers, and other healthcare professionals to ensure compliance with regulatory standards and best practices. Their goal is to balance patient care needs with organizational efficiency, ultimately improving patient outcomes and reducing unnecessary expenses.
More about Director Of Utilization Management jobs
What cities are hiring for Director Of Utilization Management jobs? Cities with the most Director Of Utilization Management job openings:
What are the most commonly searched types of Of Utilization Management jobs? The most popular types of Of Utilization Management jobs are:
What states have the most Director Of Utilization Management jobs? States with the most job openings for Director Of Utilization Management jobs include:
Director Of Utilization Management jobs near you
Infographic showing various Director Of Utilization Management job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, 1% Temporary, and 1% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $52,322 per year, or $25.2 per hour.
Director of Utilization Management

Director of Utilization Management

Village Care

Manhattan, NY • On-site

$118K - $132K/yr

Full-time

Posted 17 days ago

Job description

Position: Director of Utilization Management
Location: Hybrid (Must Reside in NY/NJ/CT)
Work Schedule: Monday - Friday, 9:00am - 5:00pm
Compensation: $118,135.58 - $132,902.53 Annual Salary
Join VillageCare as the Full-Time Director of Utilization Management and take the helm of a critical role in advancing patient care and operational excellence within New York's competitive health care landscape. This position offers the unique opportunity to lead a dedicated team while enjoying the flexibility of a remote work environment, allowing for a healthy work-life balance. With a salary range of $118,135.58 - $132,902.53, you will be compensated competitively for your expertise and commitment to customer-centric service. As a forward-thinking leader, you will tackle complex challenges head-on and implement innovative solutions that enhance our utilization management processes. You will be part of a high-performance culture that values integrity and excellence in all aspects of care delivery.
Embrace your chance to make a meaningful impact while working remotely in this vital position at VillageCare.
Let us introduce ourselves
VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.
Day to day as a Director of Utilization Management
The Director of Utilization Management (UM) at VillageCare plays a pivotal role in overseeing the daily operations of the UM Department, encompassing critical areas such as inpatient, outpatient, and long-term support service reviews. This leadership position involves managing transitions of care and discharge planning, ensuring that outpatient services align with the VillageCareMAX benefit profile. The Director will develop and direct annual departmental programs and monitor key performance indicators to promote effective utilization management functions. Focused on delivering quality, medically appropriate care that corresponds with the severity of illness and members' benefit coverage, the role also involves innovating UM initiatives designed for cost containment and quality enhancement. Additionally, compliance with CMS Model of Care (MOC) requirements is essential.
The Director is responsible for maintaining adequate staffing levels and ensuring comprehensive training and ongoing education for both clinical and non-clinical UM personnel, thereby fostering a skilled and efficient team.
Are you the Director of Utilization Management we're looking for?
To excel as the Director of Utilization Management at VillageCare, candidates must possess a robust skill set that combines leadership, analytical, and healthcare management capabilities. A minimum of five years of management experience in a health-related field, alongside three years in a quality management role, is essential for navigating the complexities of utilization management. Proficiency in analyzing data to drive improvement activities is crucial, as is a deep understanding of the regulatory structures governing quality management within Medicare and Medicaid health plans. Candidates should hold a Bachelor's Degree, with a preference for a Master's Degree, and must have an active NYS (RN) License or be willing to obtain it within three months of hire.
Strong communication and interpersonal skills are necessary for effective collaboration and to foster a culture of excellence within the team, ensuring optimal patient care and compliance with industry standards.
Knowledge and skills required for the position are:
  • A minimum of 5 years management experience in a health-related field
  • A minimum of 3 years' experience in a quality management position
  • Experience analyzing and using data to drive improvement activities
  • Knowledge of regulatory structure governing quality management in Medicare and Medicaid health plans.
  • Bachelor's Degree required. Master's degree preferred
  • Active NYS (RN) License or willing to obtain within 3 months of hire required
Your next step
If you believe that this position matches your requirements, applying for it is a breeze. Best of luck!

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