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Director Of Utilization Jobs (NOW HIRING)

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...

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$18K

$52.3K

$84K

How much do director of utilization jobs pay per year?

As of Jul 8, 2026, the average yearly pay for director of utilization in the United States is $52,322.00, according to ZipRecruiter salary data. Most workers in this role earn between $40,000.00 and $60,000.00 per year, depending on experience, location, and employer.

What is the highest paying job in healthcare management?

The highest paying roles in healthcare management often include Chief Executive Officers (CEOs) of healthcare organizations and hospital administrators, with salaries exceeding $150,000 annually. These positions require extensive experience, strong leadership skills, and often advanced degrees such as an MBA or healthcare administration certification.

What does a director of utilization management do?

A director of utilization management oversees the review and approval of healthcare services to ensure they are necessary, appropriate, and cost-effective. They develop policies, coordinate with medical staff, and use data analysis tools to optimize resource use and improve patient care outcomes.

What jobs in the US pay 300,000 a year?

In the US, roles such as Director of Utilization, senior healthcare executives, specialized physicians, and certain executive positions in finance or technology can earn $300,000 or more annually. These roles typically require advanced degrees, extensive experience, and strong leadership or technical skills.

What does a Director of Utilization do?

A Director of Utilization oversees the utilization management process within healthcare organizations, ensuring that patients receive appropriate, efficient, and cost-effective care. They are responsible for developing and implementing policies to evaluate the necessity, appropriateness, and efficiency of medical services. Their role often includes supervising utilization review staff, analyzing data to improve patient outcomes, and ensuring compliance with healthcare regulations and payer requirements. This position is crucial for balancing quality care with cost control and resource management.

What is the difference between Director Of Utilization vs Utilization Manager?

AspectDirector Of UtilizationUtilization Manager
CredentialsBachelor's degree, often with healthcare or related certificationsBachelor's degree, relevant certifications may be preferred
Work EnvironmentStrategic planning, overseeing utilization across departmentsOperational focus, managing daily utilization activities
Industry UsageCommon in healthcare, insurance, and staffing agenciesTypically found in healthcare and staffing industries
Primary FocusSetting policies and strategies for optimal resource useImplementing utilization policies and monitoring compliance

The main difference is that the Director Of Utilization focuses on strategic planning and policy development, while the Utilization Manager handles day-to-day management and implementation of utilization practices. Both roles are essential in optimizing resource use within organizations, especially in healthcare and staffing sectors.

What are some common challenges faced by a Director of Utilization in managing resource allocation across multiple departments?

A Director of Utilization often encounters the challenge of balancing resource allocation among departments with competing priorities while ensuring compliance with regulations and organizational goals. Coordinating with clinical and administrative teams to optimize patient flow, reduce unnecessary utilization, and monitor key metrics requires strong communication and analytical skills. Additionally, adapting to shifting healthcare policies and payer requirements can add complexity to daily operations. Proactively addressing these challenges through cross-functional collaboration and continuous process improvement is key to success in this role.

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

To thrive as a Director of Utilization, you need in-depth knowledge of utilization management, healthcare regulations, and clinical review processes, typically supported by an advanced degree in healthcare or nursing and relevant licensure. Familiarity with utilization management software, electronic health records (EHRs), and data analysis tools is essential for overseeing workflow and compliance. Strong leadership, communication, and critical thinking skills help in guiding teams, collaborating with providers, and making complex decisions. These competencies are crucial to ensure efficient resource use, regulatory compliance, and optimal patient care outcomes.

What jobs pay 500,000 a year in the US?

High-level executive roles such as Chief Executive Officers, Chief Financial Officers, and other C-suite positions often have annual compensation exceeding $500,000, especially in large corporations. Additionally, specialized roles like certain surgeons, investment bankers, and successful entrepreneurs can also reach or surpass this income level, often requiring advanced skills, extensive experience, and significant responsibility.
What cities are hiring for Director Of Utilization jobs? Cities with the most Director Of Utilization job openings:
What states have the most Director Of Utilization jobs? States with the most job openings for Director Of Utilization jobs include:
Director Of Utilization jobs near you
Director of Utilization & Benefit Management

Director of Utilization & Benefit Management

Samaritan Health Services

Corvallis, OR • On-site

$58.29 - $87.43/hr

Full-time

Posted 9 days ago

Samaritan Health Services rating

7.4

Company rating: 7.4 out of 10

Based on 64 frontline employees who took The Breakroom Quiz

260th of 880 rated healthcare providers

Job description

  • Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.
    As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.
    This is a remote position in which we are able to employ in the following states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
  • JOB SUMMARY/PURPOSE
    • Responsible for delivering operational oversight for the Utilization Management (UM), Behavioral Health (BH), Social Determinants of Health (SDOH), Health Related Social Needs (HRSN), and Health Equity (HE) teams. Ensures the delivery of medically necessary, cost-effective, and high-quality care through evidence-based UM processes that fully comply with CMS, OHA and other contractual requirements while ensuring that health equity goals are identified and addressed. Fulfills the role of the designated Health Equity Administrator and oversees all health equity initiatives including the Community Health Assessment (CHA), Community Health Improvement Plan (CHIP), and the Health Equity Plan (HEP). Drives clinical and operational excellence across the teams responsible for all UM, BH, SDOH, HRSN, HE functions, including prior authorizations, concurrent reviews, and service requests. Provides oversight of engagement with key community partners including the social care infrastructure. Works closely with executive leadership, Behavioral Health leadership, community partners, counties within the service area, and state agencies.
  • EXPERIENCE/EDUCATION/QUALIFICATIONS
    • Bachelor's degree required. Master's degree in a related field preferred.
    • Current unencumbered Oregon RN license required.
    • Five (5) years of leadership experience in utilization review, case management, quality improvement, or a related healthcare area required.
    • Experience in the following required:
      • Managed care and specialty healthcare organizations.
      • Regulatory compliance.
      • EHRs.
      • Data analytics.
      • Technology integration.
      • Healthcare operations.
      • Process optimization.
    • Experience in the following preferred:
      • CHA/CHIP, Health Equity Plans, or NCQA Health Equity standards.
      • Overseeing community benefit investments, grants, or value-based funding models.
      • HRSN, social care networks, and cross-sector partnerships.
      • Working with advisory councils or governance bodies.
      • Utilizing Milliman Care Guidelines (MCG) criteria and other state-specific authorization requirements.
  • KNOWLEDGE/SKILLS/ABILITIES
    • Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
    • Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
    • Critical thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
    • Communication and team building - Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
  • PHYSICAL DEMANDS
    • Rarely
      (1 - 10% of the time)
      Occasionally
      (11 - 33% of the time)
      Frequently
      (34 - 66% of the time)
      Continually
      (67 - 100% of the time)
      LIFT (Floor to Waist: 0"-36") 0-20 Lbs
      LIFT (Knee to chest: 24"-54") 0 - 20 Lbs
      LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
      CARRY 1-handed, 0 - 20 pounds
      CARRY 2-handed, 0 - 20 pounds
      KNEEL (on knees)
      BEND FORWARD at waist
      CLIMB - STAIRS
      STAND
      WALK - LEVEL SURFACE
      ROTATE TRUNK Standing
      REACH - Upward
      PUSH (0-20 pounds force)
      PULL (0-20 pounds force)
      SIT
      ROTATE TRUNK Sitting
      REACH - Forward
      MANUAL DEXTERITY Hands/wrists
      FINGER DEXTERITY
      PINCH Fingers
      GRASP Hand/Fist
      None specified

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