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Director Of Utilization Review Jobs (NOW HIRING)

Wellpath

Director Utilization Mgmt

Lemoyne, PA

Overview The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within their assigned ...

Franciscan Health

Utilization Review Coordinator

Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes. * Communicate with physicians, patients, members of the Healthcare team, Coordinated ...

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

As of Aug 6, 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?

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 August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Director Utilization Mgmt

Wellpath

Lemoyne, PA

Full-time

Re-posted 20 days ago

Wellpath rating

7.1

Company rating: 7.1 out of 10

Based on 93 frontline employees who took The Breakroom Quiz

377th of 887 rated healthcare providers

Job description

Overview

The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within their assigned area. They provide guidance and direction to medical staff in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders, and works collaboratively with internal teams to optimize care delivery and achieve operational goals.


Responsibilities

  • Ensure the use of nationally recognized criteria and evidence-based standards for inpatient concurrent reviews and offsite service requests.
  • Manage UM staff including performance reviews, employee development, hiring, coaching, counseling, and retention.
  • Lead UM process improvements, facilitate patient care goals, and utilize data research to reduce length of inpatient stays and decrease ED admissions.
  • Evaluate and recommend policy improvement related to utilization review system, and provide UM updates and participate in meetings.
  • Establish and monitor progress towards UM program goals, maintain offsite service and UM tracking/reporting, and facilitate regular meetings with partner hospital clinical regarding offsite services.

Qualifications

Education

  • Medical Doctor (M.D.) or Osteopathic Doctor (D.O.) from an accredited university

Experience

  • One (1) year of experience in utilization management is required.
  • Excellent communication and organizational skills required.
  • Experience in Performance and/or Quality Improvement preferred.

Licenses/Certifications

  • Current license in state of employment to practice medicine

What Wellpath employees say

Pay

Benefits

Hours and flexibility

Workplace

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