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Director Optum Utilization Review Jobs in Rochester, NH

GLC On-The-Go

Travel Utilization Management RN

Exeter, NH · On-site

$1.9K - $2.1K/wk

Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 36 hours per week * Shift: 12 hours * Employment Type: Travel GLC is hiring: RN Manager/Director LTC/SNF - Exeter, NH - 8 ...

The Ridge RTC

Program Manager

Milton, NH

... and Utilization Review team members. * Develop direct care team that implements the company's core beliefs into all aspects of client care and program services. Qualifications * Understanding of ...

Prime Staffing

Travel RN Care Manager

York, ME · On-site

Certification by a nationally recognized case management or utilization review organization ... We offer a wide range of staffing services including temporary, temp-to-perm, and direct hire ...

The Ridge RTC

Program Manager

Milton, NH · On-site

$65K - $70K/yr

... and Utilization Review team members. * Develop direct care team that implements the company's core beliefs into all aspects of client care and program services. Qualifications * Understanding of ...

Business Integra LLC

RN Case Manager

Concord, NH · On-site

... and utilization review. * Excellent communication, organizational, and problem-solving skills. * BLS certification (required); ACLS preferred. Why Join Us? * Competitive pay with weekly direct ...

Zunch Staffing

Laboratory Director

Portsmouth, NH

$125K - $135K/yr

Oversees the financial operation for the laboratory by monitoring resource utilization, identifying ... Develops and implements policies and procedures and verifies annual review of all policies and ...

Protouch Staffing

Road Service Director

Exeter, NH · On-site

$90K - $120K/yr

hiring a Road Service Director to lead the next phase of growth in our road service business. This ... utilization, parts margin, operating expense * Experience with service writing, invoice review, or ...

Aluma Home Care

Director of Operations

Concord, NH · On-site

Director of Operations Aluma Home Care - Manchester, New Hampshire Position Title Director of ... Review productivity, utilization, and profitability reports. * Identify opportunities for agency ...

Aluma Home Care

Director of Operations

Dover, NH · On-site

Director of Operations Aluma Home Care - Manchester, New Hampshire Position Title Director of ... Review productivity, utilization, and profitability reports. * Identify opportunities for agency ...

Aluma Home Care

Director of Operations

Concord, NH

Director of Operations Aluma Home Care - Manchester, New Hampshire Position Title Director of ... Review productivity, utilization, and profitability reports. * Identify opportunities for agency ...

Aluma Home Care

Director of Operations

Dover, NH

Director of Operations Aluma Home Care - Manchester, New Hampshire Position Title Director of ... Review productivity, utilization, and profitability reports. * Identify opportunities for agency ...

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All JobsOptum Utilization Review JobsDirector Optum Utilization Review JobsDirector Optum Utilization Review Jobs in Rochester, NH

Director Optum Utilization Review information

See Rochester, NH salary details

$17.6K

$51.2K

$82.2K

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

As of Jul 6, 2026, the average yearly pay for director optum utilization review in Rochester, NH is $51,208.00, according to ZipRecruiter salary data. Most workers in this role earn between $39,100.00 and $58,700.00 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.

What are popular job titles related to Director Optum Utilization Review jobs in Rochester, NH? For Director Optum Utilization Review jobs in Rochester, NH, the most frequently searched job titles are:
What job categories do people searching Director Optum Utilization Review jobs in Rochester, NH look for? The top searched job categories for Director Optum Utilization Review jobs in Rochester, NH are:
Director Optum Utilization Review jobs near you

Director, Utilization Review

Cobalt Benefits Group LLC

Exeter, NH • On-site

$135K - $155K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 17 days 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