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Director Of Utilization Review Jobs (NOW HIRING)

UHS

Director of Utilization Review

Gulfport, MS · On-site

The Director of Utilization Review : will assume responsibility for the functioning of the Utilization Review Department and provide utilization review services in a manner consistent with the ...

Human Resources

Utilization Review Coordinator

Aurora, CO · On-site

$64K/yr

Reporting to the Director of Utilization Review with a dotted-line relationship to the Director of Revenue Cycle Management, the UR and RCM Support Coordinator works in close partnership with billing ...

Bayside Marin

Director of Utilization

San Rafael, CA · On-site

$105K - $130K/yr

We are seeking a Director of Utilization Review to lead utilization management processes that support appropriate care delivery, regulatory compliance, and effective use of patient benefits. This ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

Responsibilities Lighthouse Care Center of Augusta is seeking a dedicated, compassionate Director of Utilization Review to add to our growing team. Lighthouse Care Center of Augusta has been ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...

Acadia Healthcare

Director of Utilization

San Rafael, CA · On-site

$105K - $130K/yr

We are seeking a Director of Utilization Review to lead utilization management processes that support appropriate care delivery, regulatory compliance, and effective use of patient benefits. This ...

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How much do director of utilization review jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for director of utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a director of utilization review?

A Director of Utilization Review is a healthcare management professional responsible for overseeing the utilization review process in hospitals or healthcare organizations. This role ensures that medical services provided to patients are necessary, appropriate, and efficient, while also complying with regulatory and insurance requirements. The Director supervises a team, manages policies, analyzes data, and collaborates with medical staff to optimize patient care and resource use. They play a key role in balancing quality care with cost-effective practices.

What are the key skills and qualifications needed to thrive as a director of utilization review?

To thrive as a Director of Utilization Review, you need strong clinical expertise, analytical skills, and an advanced degree in nursing or a related healthcare field—often with RN licensure and significant case management experience. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory standards like CMS and Joint Commission are typically required. Leadership, effective communication, and critical thinking are vital soft skills for overseeing teams and collaborating with healthcare providers. These skills and qualifications ensure efficient resource use, regulatory compliance, and optimal patient care outcomes.

What are some common challenges faced by a director of utilization review, and how can they be addressed?

Directors of Utilization Review often encounter challenges such as balancing regulatory compliance with operational efficiency, managing diverse teams, and ensuring consistent application of utilization management criteria. Addressing these challenges typically involves staying up to date with changing healthcare regulations, fostering open communication within multidisciplinary teams, and implementing robust training programs. Leveraging data analytics tools can also help streamline review processes and improve decision-making, which supports both patient care quality and organizational goals.

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

AspectDirector Of Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a registered nurse (RN) license, often with management experienceRequires an RN license and clinical experience
Work EnvironmentOversees utilization review teams, manages policies, and collaborates with healthcare providersPerforms clinical reviews, assesses patient records, and makes utilization decisions
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, clinics, insurance companies

The main difference is that the Director Of Utilization Review manages teams and policies, focusing on strategic oversight, while the Utilization Review Nurse conducts clinical assessments and reviews patient cases. Both roles require nursing credentials but differ in scope and responsibilities.

Is a director of utilization review a stressful job?

A director of utilization review often faces stress due to managing complex case evaluations, ensuring compliance with healthcare regulations, and meeting organizational goals. The role requires strong decision-making skills, attention to detail, and the ability to handle high workloads, which can contribute to job-related stress.

What degree do I need for a Director Of Utilization Review?

A Director of Utilization Review typically needs a bachelor's degree in healthcare administration, nursing, or a related field, with many employers preferring a master's degree such as an MBA or a master's in healthcare management. Relevant experience in healthcare, strong knowledge of insurance and medical policies, and professional certifications like Certified Professional in Healthcare Quality (CPHQ) can also be important. Leadership skills and familiarity with utilization review tools are essential for this role.
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Director Of Utilization Review jobs near you
Infographic showing various Director Of Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Director of Utilization Review

New Vista Behavioral Health

Cincinnati, OH • On-site

$78K - $100K/yr

Full-time

Posted 3 days ago

New

Job description

Corporate Director of Utilization Review

New Vista Behavioral Health

Pay Range: $78k - $100k per year
Schedule: Full Time
Location: Blue Ash, OH

New Vista Behavioral Health is seeking an experienced Corporate Director of Utilization Review to provide strategic leadership and oversight of utilization review and utilization management across our behavioral health organization.

This is a high-impact corporate leadership role responsible for ensuring clinically appropriate, timely, and financially responsible utilization of behavioral health services. The Director will partner with clinical, medical, operations, revenue cycle, quality, compliance, admissions, discharge planning, and payer relations teams to optimize authorizations, reduce avoidable denials, support appropriate length of stay, and promote timely transitions of care.

Key Responsibilities
  • Lead and oversee the organization’s enterprise-wide Utilization Review program and establish consistent best practices across facilities and programs.
  • Develop and implement standardized UR policies, workflows, performance expectations, and quality metrics.
  • Oversee initial, concurrent, continued-stay, retrospective, and discharge-related utilization reviews.
  • Ensure timely and accurate submission of clinical information and authorization requests to managed care organizations and other payers.
  • Monitor authorization outcomes, denials, length of stay, continued-stay days, and other utilization trends.
  • Develop strategies to prevent avoidable denials and improve payer authorization and appeal outcomes.
  • Oversee peer-to-peer reviews, clinical escalations, and medical necessity appeals.
  • Partner with clinical leadership to ensure documentation supports medical necessity, level of care, treatment needs, and continued stay.
  • Establish and monitor corporate UR dashboards and key performance indicators.
  • Identify trends and opportunities for operational, clinical, and financial improvement.
  • Provide coaching, mentoring, and leadership to facility-level UR teams and managers.
  • Collaborate with Revenue Cycle, Payer Relations, Quality, Compliance, Medical Staff, and Operations to resolve utilization and reimbursement challenges.
  • Maintain compliance with applicable regulatory, accreditation, payer, and organizational requirements.
  • Serve as the organization’s subject-matter expert on behavioral health utilization management and medical necessity.
Qualifications
  • Bachelor’s degree in Nursing, Healthcare Administration, Social Work, Psychology, or a related healthcare field required.
  • Master’s degree preferred.
  • Active clinical license or applicable professional credential preferred.
  • 7+ years of progressive healthcare experience, including significant behavioral health utilization review/management experience.
  • 3–5+ years of leadership experience, preferably in a multi-site or corporate healthcare environment.
  • Strong knowledge of behavioral health levels of care, medical necessity, payer authorization, concurrent review, denials, peer-to-peer reviews, and appeals.
  • Demonstrated success improving authorization outcomes and reducing avoidable denials.
  • Strong analytical, organizational, communication, and leadership skills.
  • Experience with behavioral health EHRs, payer portals, and utilization management systems preferred.
  • Knowledge of InterQual, MCG, ASAM, LOCUS, or other applicable clinical criteria is a plus.

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