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Director Utilization Management Jobs in Tennessee

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

Registered Nurse Utilization Management Full Time, 80 Hours Per Pay Period, Day Shift Covenant ... Communicates with hospital and payor medical directors in order to correctly determine the medical ...

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

Communicates with hospital and payor medical directors in order to correctly determine the medical ... Collaborates with payor utilization management liaisons and medical directors as applicable.

Summit BHC

The Utilization Management Manager is responsible for the overall management of the UM department ... Identifies and forwards charts for review based on outlying data to the Medical Director.

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Director Utilization Management information

See Tennessee salary details

$16.3K

$47.5K

$76.2K

How much do director utilization management jobs pay per year?

As of Aug 27, 2026, the average yearly pay for director utilization management in Tennessee is $47,488.00, according to ZipRecruiter salary data. Most workers in this role earn between $36,300.00 and $54,500.00 per year, depending on experience, location, and employer.

What is a director utilization management?

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.

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 does a director of utilization management do?

A director of utilization management oversees the review and approval of healthcare services to ensure they are medically necessary and cost-effective. They develop policies, manage teams of reviewers, and collaborate with healthcare providers and insurance companies to optimize patient care and resource utilization.

What are the most commonly searched types of Utilization Management jobs in Tennessee?

The most popular types of Utilization Management jobs in Tennessee are:

What are popular job titles related to Director Utilization Management jobs in Tennessee?

For Director Utilization Management jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Director Utilization Management jobs in Tennessee look for?

The top searched job categories for Director Utilization Management jobs in Tennessee are:

What cities in Tennessee are hiring for Director Utilization Management jobs?

Cities in Tennessee with the most Director Utilization Management job openings:

Director Utilization Management jobs near you
Infographic showing various Director Utilization Management job openings in Tennessee as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $47,488 per year, or $22.8 per hour.

Utilization Management Nurse

ArchWell Health

Nashville, TN • On-site

Full-time

Re-posted 17 days ago

ArchWell Health rating

8.0

Company rating: 8.0 out of 10

Based on 20 frontline employees who took The Breakroom Quiz

3rd of 244 rated social care providers

Job description

Job Summary:
Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating medical services, treatments, and procedures. This role identifies trends for opportunities to educate and collaborate with healthcare providers, patients, and specialists to optimize resource utilization and improve patient outcomes.
Duties/Responsibilities:
  • Conducts prospective, concurrent, and retrospective utilization reviews for medical necessity to ensure treatment and services are appropriate and necessary by reviewing medical records and treatment plans.
  • Works collaboratively with healthcare providers and Medical Directors to provide guidance on approvals or requests for health plan determination reviews as applicable utilizing CMS clinical guidelines and insurance policies.
  • Maintains accurate and detailed records of reviews, interventions, and communications to ensure adherence to health plan requirements and organizational policies.
  • Analyze utilization trends to ensure progress towards organizational goals
  • Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
  • Collaborates with Network and specialists to identify opportunities to educate on value-based care, resolve specialty gaps by markets, improve cost-effectiveness and coordination of care to meet patient needs.

Required Skills/Abilities:
  • Strong knowledge of utilization management functions in value-based care, including data analysis, claims review, reimbursement practices, and medical records reviews.
  • Thorough, in-depth knowledge of evidence-based practice, legal rules and regulations and best practices in healthcare
  • Ability to effectively leverage business and organizational knowledge within and across functional areas
  • Must possess a high degree of emotional intelligence and integrity, driven and focused work ethic
  • Continuous desire to learn and embrace new methods; ability to adapt and be resilient.
  • Self-starter with the ability to think creatively and work effectively
  • Ability to build a relationship and work effectively with various seniorities and diverse populations.
  • Excellent critical reasoning, decision-making, and problem-solving skills to make informed decisions and ensure effective resource utilization while maintaining quality patient care.
  • Willingness and ability to travel, up to 20%

Education and Experience:
  • AA/AS degree in Nursing required; BA/BS degree in Nursing (BSN) or Healthcare Administration preferred
  • A valid, active Registered Nurse (RN) license in state(s) of employment required
  • A minimum of 3 years', current direct utilization management required
  • Work in an acute care facility, community-based clinic, public health department or specialization with the senior population preferred
  • Proficient PC skills
  • Fluency in Spanish or other languages spoken by people in the communities we serve is desirable, but not required

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

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About ArchWell Health

Sourced by ZipRecruiter

At ArchWell Health, we help our members lead healthier lives through superior senior primary care and stronger patient-to-doctor relationships. You’ll find plenty of reasons to love being an ArchWell Health member. You’ll also discover that they add up to something huge—a healthier and happier you.

Industry

Outpatient health care

Company size

11 - 50 Employees

Headquarters location

Nashville, TN, US

Year founded

2020

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