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Director Of Utilization Review Jobs (NOW HIRING)

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

Director of Utilization Review * Schedule: Full-Time, Weekdays (Weekend availability as needed). * Location: Remote Key Responsibilities: * Manage a caseload of 50-75 patients and authorize 15-25 ...

Wellpath

Director Utilization Mgmt

Lemoyne, PA · On-site

$199K - $249K/yr

How you make a difference The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives ...

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

As of Jun 10, 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 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 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 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.

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

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.
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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 June 2026, with employment types broken down into 99% Full Time, and 1% Part Time. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Specialist

Banyan Treatment Centers - Texas

Pompano Beach, FL • Remote

$45K - $65K/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Job description

 Exciting Opportunity with Banyan Treatment Centers!

We are seeking a Utilization Review Specialist to join our corporate team in Pompano Beach, FL. The position is responsible for contacting external case managers and managed care organizations for pre-authorization and concurrent reviews for the duration of a patient’s treatment stay. They also establish and maintain contracts with managed care companies and requests rate increases when deemed appropriate.

Position Details:
  • Reports To: Director of Utilization Review
  • Schedule: Full-Time, Weekdays (Weekend availability as needed).
  • Location: Remote
Key Responsibilities:

  • Manage a caseload of 50–75 patients and authorize 15–25 cases daily, ensuring timely utilization reviews and appropriate level of care.

  • Verify insurance benefits, coordinate authorizations, and communicate effectively with managed care providers.

  • Conduct admission and continuing-stay reviews to assess medical necessity and ensure compliance with treatment standards.

  • Collaborate with clinical and billing departments to support discharge planning, documentation, and timely reimbursement.

  • Identify and address over/underutilization trends and assist in resolving outstanding case issues with insurers.

Requirements:
  • High School diploma or equivalent; graduate degree in a health or behavioral health related field preferred.
  • Minimum of one-year experience working in a utilization review position (psychiatric or chemical dependency).
    Why Join Banyan Treatment Centers?

    This is more than a job, it’s a chance to be a vital part of what recovery looks like after treatment. As a Utilization Review Specialist, you’ll help ensure that each client leaves treatment with a clear plan, strong connections, and the resources they need to continue their recovery journey with confidence.

    • Join a Mission-Driven, Nationally Recognized Organization: We’re accredited by the Joint Commission and backed by TPG’s Rise Fund, with 18 locations and Telehealth services nationwide.
    • Champion the Continuum of Care: Be a key player in ensuring clients transition successfully from treatment into long-term recovery supports.
    • Work in Partnership: Collaborate with clinical, operational, and business development teams, as well as families and external partners, to make sure no detail is missed.
    • Enjoy Comprehensive Benefits: Including medical, vision, and dental insurance; whole and term life insurance; short- and long-term disability coverage; 401(k) with employer match; paid time off and holidays; and wellness, assistance, and referral programs.
    Apply Now!

    If you're passionate about building bridges to lasting recovery and ensuring every patient has a plan beyond our doors, apply today and help us continue making a difference at Banyan Treatment Centers.

    We are an Equal Opportunity Employer and welcome applicants of all backgrounds. We encourage veterans, active-duty military, and first responders to apply in support of our First Responders Program.
     
     

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