Utilization Management Nurse Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care ...
Utilization Management Nurse Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
The primary role of the Utilization Management (UM) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that members receive all appropriate ...
The primary role of the Utilization Management (UM) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that members receive all appropriate ...
Utilization Review Nurse- Remote
Franklin, TN · On-site +1
The primary role of the Utilization Management (UM) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that members receive all appropriate ...
Utilization Review Nurse- Remote
Franklin, TN · On-site +1
The primary role of the Utilization Management (UM) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that members receive all appropriate ...
The primary role of the Utilization Management (UM) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that members receive all appropriate ...
The primary role of the Utilization Management (UM) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that members receive all appropriate ...
Director Case Management - Memphis TN (relo avail) to $165,000
Memphis, TN · On-site
$110K - $165K/yr
Director Case Management LOCATION: Memphis, Tennessee ***Relocation Assistance Available BASE ... Utilization Management supporting medical necessity and denial prevention; Transition Management ...
Director Case Management - Memphis TN (relo avail) to $165,000
Memphis, TN · On-site
$110K - $165K/yr
Director Case Management LOCATION: Memphis, Tennessee ***Relocation Assistance Available BASE ... Utilization Management supporting medical necessity and denial prevention; Transition Management ...
Director Case Management - Memphis TN (relo avail) to $165,000
Memphis, TN · On-site
$110K - $165K/yr
Director Case Management LOCATION: Memphis, Tennessee ***Relocation Assistance Available BASE ... Utilization Management supporting medical necessity and denial prevention; Transition Management ...
Quick apply
Director Case Management - Memphis TN (relo avail) to $165,000
Memphis, TN · On-site
$110K - $165K/yr
Director Case Management LOCATION: Memphis, Tennessee ***Relocation Assistance Available BASE ... Utilization Management supporting medical necessity and denial prevention; Transition Management ...
Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction; Care ...
Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction; Care ...
RN Utilization Review
Knoxville, TN · On-site
$63K - $65K/yr
Apply your RN clinical knowledge and experience to assist in the management of complex medical ... Two (2) years of direct clinical experience as an RN is required.. TAKING CARE OF YOU : * Seeks ...
RN Utilization Review
Knoxville, TN · On-site
$63K - $65K/yr
Apply your RN clinical knowledge and experience to assist in the management of complex medical ... Two (2) years of direct clinical experience as an RN is required.. TAKING CARE OF YOU : * Seeks ...
RN Utilization Review
Memphis, TN · On-site
$63K - $65K/yr
Apply your RN clinical knowledge and experience to assist in the management of complex medical ... Two (2) years of direct clinical experience as an RN is required.. TAKING CARE OF YOU : * Seeks ...
RN Utilization Review
Memphis, TN · On-site
$63K - $65K/yr
Apply your RN clinical knowledge and experience to assist in the management of complex medical ... Two (2) years of direct clinical experience as an RN is required.. TAKING CARE OF YOU : * Seeks ...
RN Utilization Review
Nashville, TN · On-site
$63K - $65K/yr
Apply your RN clinical knowledge and experience to assist in the management of complex medical ... Two (2) years of direct clinical experience as an RN is required.. TAKING CARE OF YOU : * Seeks ...
New
RN Utilization Review
Nashville, TN · On-site
$63K - $65K/yr
Apply your RN clinical knowledge and experience to assist in the management of complex medical ... Two (2) years of direct clinical experience as an RN is required.. TAKING CARE OF YOU : * Seeks ...
New
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
Maintains frequent and close working relationships with the Director of Utilization Review ... Demonstrates excellent organizational and time management skills. * Demonstrates a high level of ...
Maintains frequent and close working relationships with the Director of Utilization Review ... Demonstrates excellent organizational and time management skills. * Demonstrates a high level of ...
Field Medical Director, Vascular Surgeon
Nashville, TN · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Field Medical Director, Vascular Surgeon
Nashville, TN · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Manager of Utilization Review
Franklin, TN · On-site +1
Maintains frequent and close working relationships with the Director of Utilization Review ... Demonstrates excellent organizational and time management skills. * Demonstrates a high level of ...
Manager of Utilization Review
Franklin, TN · On-site +1
Maintains frequent and close working relationships with the Director of Utilization Review ... Demonstrates excellent organizational and time management skills. * Demonstrates a high level of ...
Utilization Review and Support Specialist Classification: Full-time, non-exempt Minimum ... to the Director. Manage and conduct state billing in TNWITS system. Batch and enter TNWITS ...
Quick apply
Utilization Review and Support Specialist Classification: Full-time, non-exempt Minimum ... to the Director. Manage and conduct state billing in TNWITS system. Batch and enter TNWITS ...
Billing Specialist and Utilization Review for Recovery Clients
Nashville, TN · On-site
$18.75 - $25.25/hr
) Utilization Review and Support Specialist Classification: Full-time, non-exempt Minimum ... to the Director. Manage and conduct state billing in TNWITS system. Batch and enter TNWITS ...
Billing Specialist and Utilization Review for Recovery Clients
Nashville, TN · On-site
$18.75 - $25.25/hr
) Utilization Review and Support Specialist Classification: Full-time, non-exempt Minimum ... to the Director. Manage and conduct state billing in TNWITS system. Batch and enter TNWITS ...
Value Analysis Director
Lebanon, TN · On-site
Drive implementation of system-wide product standardization, utilization management, and clinical ... Direct multiple projects and tasks in a fast-paced environment. * Assimilates information from a ...
Value Analysis Director
Lebanon, TN · On-site
Drive implementation of system-wide product standardization, utilization management, and clinical ... Direct multiple projects and tasks in a fast-paced environment. * Assimilates information from a ...
Director Utilization Management information
See Tennessee salary details
$16.3K - $21.8K
1% of jobs
$21.8K - $27.2K
3% of jobs
$27.2K - $32.7K
11% of jobs
$36.2K is the 25th percentile. Wages below this are outliers.
$32.7K - $38.1K
16% of jobs
$38.1K - $43.6K
15% of jobs
The median wage is $45.2K / yr.
$43.6K - $49K
16% of jobs
$53.5K is the 75th percentile. Wages above this are outliers.
$49K - $54.5K
17% of jobs
$54.5K - $59.9K
9% of jobs
$59.9K - $65.3K
7% of jobs
$65.3K - $70.8K
3% of jobs
$70.8K - $76.2K
2% of jobs
$16.3K
$47.5K
$76.2K
How much do director utilization management jobs pay per year?
As of Aug 7, 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 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?
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 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:
- Remote Utilization Management Pharmacist
- Healthcare Revenue Cycle Manager
- Remote Cvs Utilization Management Nurse
- Flexible Cvs Utilization Management Nurse
- Independent Contractor Remote Utilization Management Nurse
- Executive Director Healthcare
- Hospice Care Cna
- Clinical Appeals Nurse
- Executive Director Of Nursing
- Cvs Health Utilization Management Remote
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:
ArchWell Health rating
8.0
Based on 20 frontline employees who took The Breakroom Quiz
3rd of 239 rated social care providers
Job description
Utilization Management Nurse
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.
- 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%
- 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.
What ArchWell Health employees say
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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