Reporting to the UM RN Director, the Manager translates department strategy, regulatory and payer ... Knowledge of utilization management and utilization review principles, including prospective ...
Reporting to the UM RN Director, the Manager translates department strategy, regulatory and payer ... Knowledge of utilization management and utilization review principles, including prospective ...
Reporting to the UM RN Director, the Manager translates department strategy, regulatory and payer ... Knowledge of utilization management and utilization review principles, including prospective ...
Reporting to the UM RN Director, the Manager translates department strategy, regulatory and payer ... Knowledge of utilization management and utilization review principles, including prospective ...
Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... LMSW, LPC, RN or LVN licensure in the state of Michigan required. 3-5 years direct clinical ...
Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... LMSW, LPC, RN or LVN licensure in the state of Michigan required. 3-5 years direct clinical ...
Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... LMSW, LPC, RN or LVN licensure in the state of Michigan required. 3-5 years direct clinical ...
Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... LMSW, LPC, RN or LVN licensure in the state of Michigan required. 3-5 years direct clinical ...
Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... LMSW, LPC, RN or LVN licensure in the state of Michigan required. 3-5 years direct clinical ...
Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... LMSW, LPC, RN or LVN licensure in the state of Michigan required. 3-5 years direct clinical ...
... of care. Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital. The UR Director leads physician weekly staffing meetings and ...
... of care. Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital. The UR Director leads physician weekly staffing meetings and ...
... of care. Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital. The UR Director leads physician weekly staffing meetings and ...
... of care. Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital. The UR Director leads physician weekly staffing meetings and ...
The Director functions as the internal resource on issues related to the appropriate utilization of resources, coordination of care across the continuum and utilization review and management. The ...
The Director functions as the internal resource on issues related to the appropriate utilization of resources, coordination of care across the continuum and utilization review and management. The ...
Under the direction of the Director of Care Coordination, the Manager of Utilization Review provides strategic, operational, and clinical leadership for the Utilization Review (UR) function. This ...
Under the direction of the Director of Care Coordination, the Manager of Utilization Review provides strategic, operational, and clinical leadership for the Utilization Review (UR) function. This ...
The Director functions as the internal resource on issues related to the appropriate utilization of resources, coordination of care across the continuum and utilization review and management. The ...
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The Director functions as the internal resource on issues related to the appropriate utilization of resources, coordination of care across the continuum and utilization review and management. The ...
The Director functions as the internal resource on issues related to the appropriate utilization of resources, coordination of care across the continuum and utilization review and management. The ...
The Director functions as the internal resource on issues related to the appropriate utilization of resources, coordination of care across the continuum and utilization review and management. The ...
PR · On-site
Responsibilities Provides strategic leadership to the daily operations of the Utilization Review Department. The Utilization Review (UR) Director is responsible for overseeing the utilization ...
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 ...
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 ...
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 ...
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 ...
Overview The Manager of Utilization Review provides operational leadership and oversight for utilization review activities across the health system. This role is responsible for ensuring clinical ...
New
Overview The Manager of Utilization Review provides operational leadership and oversight for utilization review activities across the health system. This role is responsible for ensuring clinical ...
New
Overview The Manager of Utilization Review provides operational leadership and oversight for utilization review activities across the health system. This role is responsible for ensuring clinical ...
New
Overview The Manager of Utilization Review provides operational leadership and oversight for utilization review activities across the health system. This role is responsible for ensuring clinical ...
New
Director of Utilization Management
Eagan, MN · On-site
$237K - $248K/yr
They also manage retrospective reviews after treatment has been completed, which includes oversight ... utilization of effective and appropriate services. The director ensures that business objectives ...
Director of Utilization Management
Eagan, MN · On-site
$237K - $248K/yr
They also manage retrospective reviews after treatment has been completed, which includes oversight ... utilization of effective and appropriate services. The director ensures that business objectives ...
Lead and manage a team of utilization review professionals providing guidance, training, and ... Direct and coordinate data gathering and record keeping legally required by federal and state ...
Lead and manage a team of utilization review professionals providing guidance, training, and ... Direct and coordinate data gathering and record keeping legally required by federal and state ...
RN Utilization Review
Greensboro, NC · On-site
... patient receives the direct and proper care needed. * Reviews patient records and develops ... Applies knowledge of utilization review methodologies to serve as a resource for training and ...
RN Utilization Review
Greensboro, NC · On-site
... patient receives the direct and proper care needed. * Reviews patient records and develops ... Applies knowledge of utilization review methodologies to serve as a resource for training and ...
Lead and manage a team of utilization review professionals providing guidance, training, and ... Direct and coordinate data gathering and record keeping legally required by federal and state ...
Lead and manage a team of utilization review professionals providing guidance, training, and ... Direct and coordinate data gathering and record keeping legally required by federal and state ...
Director Of Utilization Review information
See salary details
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
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?
| Aspect | Director Of Utilization Review | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a registered nurse (RN) license, often with management experience | Requires an RN license and clinical experience |
| Work Environment | Oversees utilization review teams, manages policies, and collaborates with healthcare providers | Performs clinical reviews, assesses patient records, and makes utilization decisions |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, 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.
More about Director Of Utilization Review jobs
What cities are hiring for Director Of Utilization Review jobs?
Cities with the most Director Of Utilization Review job openings:
What states have the most Director Of Utilization Review jobs?
States with the most job openings for Director Of Utilization Review jobs include:
What job categories do people searching Director Of Utilization Review jobs look for?
The top searched job categories for Director Of Utilization Review jobs are:
- Remote Aetna Utilization Review
- Full Time Weekend Utilization Review
- Seasonal Remote Utilization Review
- Utilization Review
- Temporary Medical Utilization Review Physician
- Rn Utilization Review Nurse
- Utilization Review Supervisor
- Freelance International Utilization Review Nurse
- Utilization Review Manager
- Utilization Review Nurse Compact License
Southwest General Health Center rating
6.9
Based on 46 frontline employees who took The Breakroom Quiz
545th of 1,065 rated hospitals
Job description
Summary
- POSITION INFORMATION
- Position summary:
- The Utilization Management (UM) RN Manager is responsible for the day-to-day leadership, operational oversight, and performance management of the Utilization Management nursing team. Reporting to the UM RN Director, the Manager translates department strategy, regulatory and payer requirements, approved clinical review criteria, and organizational priorities into consistent daily execution.
- The role provides direct supervision, coaching, workflow management, clinical-operational support, and performance oversight for assigned UM staff. The Manager collaborates with physician advisors/medical directors, case management, clinical operations, revenue cycle, payer relations, quality, compliance, and other stakeholders to support timely, accurate, evidence-informed utilization management decisions and appropriate stewardship of healthcare resources.
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- MINIMUM QUALIFICATIONS
- Education:
- Bachelor of Science in Nursing (BSN) required, or equivalent qualification consistent with organizational policy.
- Masters degree in Nursing, Healthcare Administration, Business Administration, Public Health, or a related field preferred.
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Required length and type of experience:- Five or more years of progressive clinical nursing and/or utilization management experience preferred, including three or more years of experience in utilization management, utilization review, case management, managed care, or a closely related function.
- Prior formal leadership experience required; two or more years of supervisory or management experience preferred.
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Required licensure, certification or registry:- Current Ohio State Board of Nursing license required.
- Certified Case Manager (CCM) certification preferred.
- Accredited Case Manager (ACM) certification preferred.
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- Core Knowledge, Skills, and Competencies
- Knowledge of utilization management and utilization review principles, including prospective, concurrent, and retrospective review.
- Knowledge of medical necessity, patient status, level-of-care review, authorization processes, payer requirements, denial prevention, and escalation pathways.
- Knowledge of evidence-based clinical review criteria and appropriate use of clinical decision-support tools.
- Knowledge of regulatory and accreditation requirements affecting utilization management and clinical review.
- Demonstrated ability in people leadership, coaching, performance management, conflict resolution, and change management.
- Demonstrated ability to interpret operational analytics and KPIs, conduct root-cause analysis, and drive process improvement.
- Demonstrated ability to communicate effectively across interdisciplinary teams, including nursing, physicians, physician advisors, payers, revenue cycle, and leadership.
- Demonstrated application of professional nursing judgment, ethical practice, confidentiality, and appropriate stewardship of healthcare resources.
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What Southwest General Health Center employees say
Pay
Benefits
Hours and flexibility
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About Southwest General
Sourced by ZipRecruiter
Industry
Hospitals
Company size
1,001 - 5,000 Employees
Headquarters location
Middleburg Heights, OH, US
Year founded
1920