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Director Of Utilization Review Jobs (NOW HIRING)

Orison

RN - Utilization Review

Elmhurst, NY · On-site

Prepare and maintain accurate documentation of utilization review activities. * Escalate cases to the appropriate physician advisor or Medical Director when criteria are not met or additional ...

Orison

RN - Utilization Review

Elmhurst, NY · On-site

Prepare and maintain accurate documentation of utilization review activities. * Escalate cases to the appropriate physician advisor or Medical Director when criteria are not met or additional ...

ADP, Inc.

Utilization Review Specialist

Knoxville, TN · On-site

$60 - $80/hr

We believe that taking care of our team allows them to take better care of others, which is why we ... The Utilization Review Specialist plays a critical role in ensuring that healthcare services ...

New

Medix

Director of Utilization Management

Pittsburgh, PA · On-site

$150 - $200/hr

Review escalated cases using established medical policy criteria. * Participate in peer-to-peer ... of payer-side / health insurance utilization management experience as a Medical Director at a ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

$55-$60 per hour Canton, MA Contract Duration: 6 Month Contract (Possibility of Extension) Position ... Collaborate with Medical Directors for complex cases, denial recommendations, and clinical ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Springfield, IL · On-site

The Director of Case Management (Utilization Management) is responsible for the leadership ... Ensure timely and accurate utilization review activities and payer communications. * Monitor ...

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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.

Utilization Review

Discovery Institute of Addictive Disorders Inc.

Marlboro, NJ • On-site

Full-time

Re-posted 13 days ago

Key responsibilities

  • Obtain initial and concurrent insurance authorizations for all levels of care.

  • Review clinical documentation to ensure it supports medical necessity and submit required information to insurance companies within specified timeframes.

  • Monitor authorization expiration dates, communicate decisions to clinical staff, and prepare and submit appeals for denied services.

Job description

Position Summary

The Utilization Review (UR) Specialist is responsible for obtaining and maintaining insurance authorizations for clients receiving substance use disorder treatment services. This position works closely with clinical staff, admissions, and insurance companies to ensure medical necessity documentation is accurate, authorizations are obtained timely, and reimbursement is maximized while maintaining compliance with payer requirements, Medicaid regulations, and accreditation standards.

Essential Duties and Responsibilities
  • Obtain initial and concurrent insurance authorizations for all levels of care.
  • Review clinical documentation to ensure it supports medical necessity.
  • Submit clinical information to insurance companies within required timeframes.
  • Monitor authorization expiration dates and request extensions before expiration.
  • Communicate authorization decisions and payer requirements to clinical staff.
  • Track approved days and notify leadership of denials or reductions in care.
  • Prepare and submit appeals for denied services when appropriate.
  • Maintain accurate authorization records in the electronic health record (EHR).
  • Work collaboratively with Admissions, Clinical, Nursing, and Billing departments.
  • Verify insurance benefits and coverage when necessary.
  • Monitor payer portals for authorization updates.
  • Assist with Medicaid and managed care authorization processes.
  • Participate in utilization review meetings and case conferences.
  • Generate reports on authorization status, denials, appeals, and payer trends.
  • Ensure compliance with Joint Commission, state, federal, and payer regulations.
  • Maintain confidentiality in accordance with HIPAA regulations.
  • Perform other duties as assigned.
Qualifications
  • High school diploma required; Associate's or Bachelor's degree preferred.
  • Minimum of two years of utilization review, case management, medical billing, or behavioral healthcare experience preferred.
  • Experience in substance use disorder or behavioral health treatment strongly preferred.
  • Knowledge of ASAM Criteria preferred.
  • Familiarity with Medicaid, commercial insurance, and managed care plans.
  • Strong organizational and time management skills.
  • Excellent verbal and written communication skills.
  • Ability to prioritize multiple cases in a fast-paced environment.
  • Proficient in Microsoft Office and electronic health record systems.
Knowledge, Skills, and Abilities
  • Understanding of insurance authorization processes.
  • Knowledge of medical necessity criteria and documentation standards.
  • Strong analytical and critical thinking skills.
  • Excellent customer service and professional communication.
  • Ability to work independently while collaborating with interdisciplinary teams.
  • Attention to detail and accuracy.
  • Ability to maintain confidentiality.
Performance Expectations
  • Maintain timely insurance authorizations with minimal lapses.
  • Reduce avoidable authorization denials.
  • Ensure documentation meets payer standards.
  • Maintain accurate records and reporting.
  • Demonstrate professionalism, teamwork, and excellent customer service.
  • Comply with all organizational policies, HIPAA, Joint Commission standards, and applicable federal and New Jersey regulations.