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Director Utilization Management Jobs (NOW HIRING)

Wellpath

Director Utilization Mgmt

Lemoyne, PA · On-site

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 ...

Wellpath

Director Utilization Mgmt

Lemoyne, PA · On-site

$199K - $249K/yr

How you make a difference The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives ...

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$18K

$52.3K

$84K

How much do director utilization management jobs pay per year?

As of Aug 3, 2026, the average yearly pay for director utilization management 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 are the key skills and qualifications needed to thrive in the Director Utilization Management position, and why are they important?

To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.

What is a Director Utilization Management job?

A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.

What are the typical daily responsibilities of a Director Utilization Management?

A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.

More about Director Utilization Management jobs
What cities are hiring for Director Utilization Management jobs? Cities with the most Director Utilization Management job openings:
What are the most commonly searched types of Utilization Management jobs? The most popular types of Utilization Management jobs are:
What states have the most Director Utilization Management jobs? States with the most job openings for Director Utilization Management jobs include:
What job categories do people searching Director Utilization Management jobs look for? The top searched job categories for Director Utilization Management jobs are:
Director Utilization Management jobs near you
Infographic showing various Director Utilization Management job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, 1% Temporary, and 1% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $52,322 per year, or $25.2 per hour.

Director, Utilization Management

Independent Living Systems

Miami, FL • On-site

Full-time

Posted 11 days ago

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Director, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Director of Utilization Management plays an essential role in ensuring that healthcare services are delivered efficiently and effectively while maintaining high standards of member care. The Director of Utilization Management is responsible for overseeing the utilization management department, developing policies and procedures that align with regulatory requirements, and implementing best practices to optimize resource use. The Director of Utilization Management will collaborate with clinical teams to assess the appropriateness of care and ensure that members receive the right services at the right time. Additionally, the Director of Utilization Management involves analyzing data to identify trends and areas for improvement, ultimately enhancing member outcomes and satisfaction. The Director of Utilization Management will lead initiatives that promote cost-effective care while ensuring compliance with healthcare regulations and standards.

Minimum Qualifications:

  • Bachelor's degree in Nursing, Healthcare Administration, or a related field.
  • 5 years of experience in utilization management or a related healthcare field.
  • Strong knowledge of healthcare regulations, policies, and best practices.

Preferred Qualifications:

  • Master's degree in Healthcare Administration, Public Health, or a related field.
  • Certification in Utilization Management (e.g., ACM, CCM) is highly desirable.
  • Experience in a leadership role within a healthcare organization.

Responsibilities:

  • Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
  • Lead and direct a team of utilization management professionals, fostering a culture of continuous improvement and excellence.
  • Direct the daily operations of the utilization management department, ensuring compliance with all regulatory requirements.
  • Develop and implement utilization management policies and procedures that align with organizational goals.
  • Collaborate with clinical staff to review and assess the appropriateness of care provided to members.
  • Analyze utilization data to identify trends, areas for improvement, and opportunities for cost savings.
  • Ensure that assigned deliverables are completed on time, including development and coordination of required contractual and regulatory submissions.
  • Develop and track key performance indicators (KPIs) to measure organizational performance, including accurate and timely reporting of required contractual regulatory reports.
  • Develop, maintain and improve management processes, policies and procedures and/or conduct management projects including development of detailed plans to achieve project objectives.
  • Perform other duties as assigned.



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