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Director Of Utilization Review Jobs in Rochester, NY

CompleteRx

Director of Pharmacy

Rochester, NY · On-site

$155K - $173K/yr

As the Director of Pharmacy, you will provide strategic leadership and operational oversight for at ... Reviews monthly financial statistics and plans expenditures within budget guidelines. * Monitors ...

CompleteRx

Director of Pharmacy

Rochester, NY · On-site

$155K - $173K/yr

As the Director of Pharmacy, you will provide strategic leadership and operational oversight for at ... Reviews monthly financial statistics and plans expenditures within budget guidelines. * Monitors ...

CompleteRx

Director of Pharmacy

Rochester, NY · On-site

$155K - $173K/yr

As the Director of Pharmacy, you will provide strategic leadership and operational oversight for at ... Reviews monthly financial statistics and plans expenditures within budget guidelines. * Monitors ...

Acacia Network

Program Director

Rochester, NY · On-site

$85K/yr

Review and approval of initial needs assessment and initial treatment plans, as needed * Knowledge ... Perform utilization reviews, monitoring case records, ensuring compliance with all contract ...

Greenlight Networks

Director of Accounting

Rochester, NY · On-site

$130K - $160K/yr

Greenlight Networks is searching for a dynamic and experienced Director of Accounting to add to our ... Prepare and review consolidated financial statements and supporting schedules * Assist in the ...

Loop Internet

Director of Accounting

Rochester, NY · On-site

$130K - $160K/yr

... Director of Accounting to add to our high performing team. We are embarking on an aggressive ... Prepare and review consolidated financial statements and supporting schedules * Assist in the ...

Troon Golf

Director of Facilities

Victor, NY · On-site

$80K - $90K/yr

The Director of Facilities will provide guidance and leadership to the entire Facilities team and ... Reviews employee satisfaction results to identify and address employee problems or concerns.

Troon

Director of Facilities

Victor, NY · On-site

$85K/yr

The Director of Facilities will provide guidance and leadership to the entire Facilities team and ... Reviews employee satisfaction results to identify and address employee problems or concerns.

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Director Of Utilization Review information

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

As of Sep 8, 2026, the average hourly pay for director of utilization review in Rochester, NY is $41.72, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 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.

What are popular job titles related to Director Of Utilization Review jobs in Rochester, NY?

For Director Of Utilization Review jobs in Rochester, NY, the most frequently searched job titles are:

What job categories do people searching Director Of Utilization Review jobs in Rochester, NY look for?

The top searched job categories for Director Of Utilization Review jobs in Rochester, NY are:

What cities near Rochester, NY are hiring for Director Of Utilization Review jobs?

Cities near Rochester, NY with the most Director Of Utilization Review job openings:

Director Of Utilization Review jobs near you
Infographic showing various Director Of Utilization Review job openings in Rochester, NY as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $86,833 per year, or $41.7 per hour.

Director of Operations (Home Care)

Always Compassionate Home Care

Rochester, NY • On-site

$120K - $135K/yr

Full-time

Posted 20 days ago

Job description

It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
Title: Director of Operations - PCS Home Care Operations
Reports To: President of Rochester
Supervises: Managers and Supervisors overseeing Intake, Staffing Coordination, and Community Outreach
Salary: $120,000 - $135,000 per year
POSITION SUMMARY
The Director of Operations is responsible for the day-to-day operational performance of the Personal Care Services (PCS) Home Care division. This position oversees Intake, Staffing Coordination, and Community Outreach, ensuring that each function operates efficiently, collaboratively, and in alignment with organizational goals, regulatory requirements, and standards of service.
The Director of Operations will support operational growth, improve processes, monitor key performance indicators, develop strong department teams, and ensure the organization has the capacity to effectively serve clients while maintaining strong relationships with employees, referral sources, community partners, and internal stakeholders.
ESSENTIAL DUTIES AND RESPONSIBILITIES
  • Provide operational leadership for the PCS Home Care division, overseeing Intake, Staffing Coordination, and Community Outreach.
  • Establish departmental goals, KPIs, performance standards, and accountability measures.
  • Oversee Intake operations, including referral management, case openings, authorizations, and intake efficiency.
  • Oversee Staffing Coordination to ensure appropriate staffing, case coverage, caregiver utilization, and timely response to staffing needs.
  • Lead Community Outreach and referral development initiatives to increase PCS census, referrals, and market presence.
  • Monitor operational performance, analyze trends, and implement strategies to improve efficiency, productivity, and service quality.
  • Ensure effective communication and collaboration between Intake, Staffing, Clinical Operations, HR, Recruitment, and other departments.
  • Recruit, develop, coach, and hold operational leaders accountable for achieving departmental goals.
  • Develop and implement process improvements, performance improvement plans, and strategies to support sustainable growth.
  • Ensure operations comply with applicable regulations, company policies, and quality standards.
  • Participate in budgeting, forecasting, and resource planning for the PCS division.
  • Build and maintain strong relationships with referral sources, community partners, and other key stakeholders.
  • Partner with the VP of Operations and executive leadership on strategic initiatives, business growth, expansion, and operational planning.
  • Provide regular reporting on operational performance, challenges, and opportunities to executive leadership.
  • Perform other duties and responsibilities as assigned by executive leadership.

QUALIFICATIONS
  • Bachelor's degree in Business Administration, Healthcare Administration, Management, or a related field required; Master's degree preferred.
  • Minimum of 5-7 years of progressive leadership experience in healthcare, home care, personal care services, or a related industry.
  • Demonstrated experience overseeing multiple operational functions and leadership teams.
  • Experience with staffing operations, intake/referral management, and community outreach preferred.
  • Strong understanding of home care operations and applicable regulatory requirements.
  • Proven ability to manage KPIs, operational performance, and organizational growth.
  • Strong leadership, communication, problem-solving, and decision-making skills.
  • Ability to manage multiple priorities in a fast-paced, high-growth environment.
  • Demonstrated ability to build strong relationships with internal and external stakeholders.
  • Strong analytical, strategic-thinking, and organizational skills.

CORE COMPETENCIES
  • Operational Leadership
  • Operational Excellence
  • Business Growth & Development
  • Performance Management
  • Staffing & Workforce Management
  • Process Improvement
  • Regulatory Compliance
  • Relationship Management
  • Team Development
  • Data-Driven Decision Making
  • Communication & Collaboration

SUCCESS MEASURES
Success in this position will be measured by the Director of Operations' ability to:
• Improve overall PCS operational performance and efficiency.
• Support and increase client census and case growth.
• Improve intake turnaround and referral conversion.
• Improve staffing coverage and reduce service disruptions.
• Strengthen caregiver utilization and retention.
• Increase referral relationships and community partnerships.
• Establish strong accountability and performance standards across departments.
• Develop effective operational leadership teams.
• Maintain compliance and quality standards while supporting growth.
• Successfully execute operational initiatives that support the long-term growth of the PCS division.
Note: This job description is intended to describe the general nature and level of work performed by employees in this position. It is not intended to be an exhaustive list of all duties, responsibilities, and qualifications required.
Always Compassionate Health is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Always Compassionate Health are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, creed, national, social or ethnic origin, political viewpoint, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, protected veteran status, citizenship status when otherwise legally able to work, or any other status protected by the laws or regulations in the locations where we operate.
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If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

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