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Director Optum Utilization Review Jobs (NOW HIRING)

Cobalt Benefits Group LLC

Director, Utilization Review

Exeter, NH · On-site

$135K - $155K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Director of Utilization Review is responsible for the strategic leadership, operational execution, and regulatory compliance of the Utilization Review (UR) program. This role ensures clinically ...

UHS

Director of Utilization Review

Gulfport, MS

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Director of Utilization Review : will assume responsibility for the functioning of the Utilization Review Department and provide utilization review services in a manner consistent with the ...

UHS

Director of Utilization Review

Gulfport, MS · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Director of Utilization Review : will assume responsibility for the functioning of the Utilization Review Department and provide utilization review services in a manner consistent with the ...

UHS

Director of Utilization Review

Gulfport, MS · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Director of Utilization Review : will assume responsibility for the functioning of the Utilization Review Department and provide utilization review services in a manner consistent with the ...

UHS

Director of Utilization Review

Gulfport, MS

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Director of Utilization Review : will assume responsibility for the functioning of the Utilization Review Department and provide utilization review services in a manner consistent with the ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

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 ...

Prime Time Healthcare

Utilization Review

Cleveland, OH · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

Now Hiring: RN Utilization Review - Middleburg Heights, OH Are you a passionate RN professional ... Competitive compensation and weekly direct deposit * Compliance Support Specialist & Onboarding ...

Prime Time Healthcare

Utilization Review

Baltimore, MD · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

Now Hiring: RN Utilization Review - Baltimore, MD Are you a passionate RN professional looking for ... Competitive compensation and weekly direct deposit * Compliance support specialist & onboarding ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

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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Director Optum Utilization Review information

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$18K

$52.3K

$84K

How much do director optum utilization review jobs pay per year?

As of Aug 18, 2026, the average yearly pay for director optum utilization review 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 difference between Director Optum Utilization Review vs Utilization Review Manager?

AspectDirector Optum Utilization ReviewUtilization Review Manager
CertificationsTypically requires certifications like CCM or URAC accreditationOften requires similar certifications, may vary by employer
Work EnvironmentWorks within Optum or similar healthcare organizations, overseeing utilization review processesManages utilization review teams, often within healthcare providers or insurance companies
ResponsibilitiesStrategic oversight of utilization review policies, compliance, and team leadershipSupervises daily review operations, staff management, and process improvements

The main difference is that the Director Optum Utilization Review typically holds a higher strategic leadership role within Optum, focusing on policy and compliance, while the Utilization Review Manager manages daily operations and staff. Both roles require similar credentials but differ in scope and level of responsibility.

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Director Optum Utilization Review jobs near you
Infographic showing various Director Optum Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $52,322 per year, or $25.2 per hour.

Director, Utilization Review

Cobalt Benefits Group LLC

South Burlington, VT • On-site

$135K - $155K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 1 hour ago

Job description

Description:

The Director of Utilization Review is responsible for the strategic leadership, operational execution, and regulatory compliance of the Utilization Review (UR) program. This role ensures clinically sound, timely, and compliant medical necessity determinations across all lines of business, while driving integration across Claims, Appeals, Stop Loss, and vendor partners. The position also advances technology-enabled utilization management, interoperability, and population health strategies in alignment with CBG’s operational and client objectives.


Clinical & Operational Leadership:

  • Provide leadership and oversight of the Utilization Review department
  • Ensure consistent, evidence-based medical necessity determinations
  • Establish and enforce clinical guidelines, documentation standards, and review protocols
  • Maintain alignment with MCG guidelines and internal clinical governance standards

Claims, Appeals & Stop Loss Integration:

  • Ensure seamless alignment between UR and Claims workflows
  • Provide clinical expertise and documentation support for Appeals processes
  • Partner with Stop Loss teams on high-cost claim reviews and determinations
  • Promote end-to-end workflow efficiency across clinical and administrative functions

Regulatory Compliance & Audit Readiness:

  • Ensure compliance with CMS, state, ERISA/non-ERISA, and accreditation requirements
  • Maintain audit-ready documentation and defensible clinical decisions
  • Oversee development and accuracy of denial and determination letters
  • Partner with Compliance and Legal to ensure regulatory alignment across all lines of business

Technology, Interoperability & Data Strategy:

  • Drive automation and digital workflow enhancements within UR
  • Enable interoperability across UR, Claims, Appeals, and vendor systems
  • Support real-time data exchange (EDI, integration platforms)
  • Leverage analytics to inform utilization trends, clinical outcomes, and population health initiatives

Quality, Training & Performance Management:

  • Establish quality assurance programs, audit processes, and performance standards
  • Develop and deliver training programs for clinical and operational staff
  • Implement dashboards and KPIs to measure productivity, compliance, and outcomes
  • Foster a culture of continuous improvement and accountability
Requirements:
  • Active Registered Nurse (RN) license
  • Minimum 5+ years of Utilization Review leadership experience
  • Strong knowledge of MCG guidelines, regulatory standards, and claims integration
  • Preferred experience within a TPA or health plan environment
  • Preferred familiarity with clinical platforms, workflow automation, and interoperability tools

Why Join Cobalt Benefits Group?

Cobalt Benefits Group is a trusted third-party administrator specializing in self-funded benefit plans. With over 30 years of experience and 180+ employees, we support employers through customized health plan administration, claims management, and specialized programs including FSAs, HSAs, COBRA, and retiree billing.

After a 60-day waiting period, full-time employees are eligible for a comprehensive benefits package, including:

  • Medical, dental, and vision coverage with employer HSA contributions
  • Company-paid life, AD&D, and disability insurance
  • 401(k) with up to a 6% employer match
  • Generous paid time off, sick time, and 10+ paid holidays
  • Flexible Spending Accounts
  • A collaborative culture with regular company events

Cobalt Benefits Group is an Equal Employment Opportunity Employer


Cobalt Benefits Group participates in E-Verify to confirm the employment eligibility of all new hires.