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Medical 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 ...

Colorado PA

$249 - $373/hr

The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over ...

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Medical Director Utilization Management information

See salary details

$13K

$232.4K

$357K

How much do medical director utilization management jobs pay per year?

As of Aug 22, 2026, the average yearly pay for medical director utilization management in the United States is $232,369.00, according to ZipRecruiter salary data. Most workers in this role earn between $198,000.00 and $284,500.00 per year, depending on experience, location, and employer.

What is a medical director utilization management?

A Medical Director of Utilization Management is a physician who oversees and ensures the appropriate use of medical resources within a healthcare organization or insurance company. Their responsibilities include reviewing clinical cases, developing utilization review policies, and working with healthcare providers to ensure that treatment plans are medically necessary and cost-effective. They play a key role in balancing patient care quality with regulatory and financial considerations, helping to improve healthcare outcomes and system efficiency.

What are the key skills and qualifications needed to thrive as a medical director utilization management?

To thrive as a Medical Director Utilization Management, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in internal medicine or a related specialty. Familiarity with utilization review processes, case management software, and regulatory frameworks such as CMS guidelines is essential. Strong leadership, analytical thinking, and effective communication skills are crucial for guiding teams and collaborating with diverse stakeholders. These competencies ensure appropriate resource utilization, regulatory compliance, and high-quality patient care within healthcare organizations.

How does a medical director utilization management typically collaborate with clinical teams and insurance providers?

A Medical Director in Utilization Management frequently works at the intersection of healthcare providers, clinical teams, and insurance companies. Their role involves reviewing clinical cases, making coverage determinations, and consulting with physicians to ensure that medical treatments are both necessary and cost-effective. Collaboration often includes participating in interdisciplinary meetings, providing guidance on complex cases, and communicating policy updates or clinical guidelines. This ensures that patient care decisions align with best practices, regulatory requirements, and payer policies.

What is the difference between Medical Director Utilization Management vs Medical Director Case Management?

AspectMedical Director Utilization ManagementMedical Director Case Management
CredentialsMedical degree, medical license, possibly board certificationMedical degree, medical license, possibly board certification
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsCase management teams, hospitals, healthcare providers
Employer & IndustryInsurance companies, managed care organizationsHospitals, healthcare systems, community health agencies
Primary FocusReviewing medical necessity and approving servicesCoordinating patient care and discharge planning

Both roles require medical credentials and involve improving patient care, but Medical Director Utilization Management primarily focuses on reviewing and approving healthcare services for insurance purposes, while Medical Director Case Management emphasizes coordinating ongoing patient care and discharge planning within healthcare settings.

More about Medical Director Utilization Management jobs

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Cities with the most Medical Director Utilization Management job openings:

What states have the most Medical Director Utilization Management jobs?

States with the most job openings for Medical Director Utilization Management jobs include:

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

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

Medical Director Utilization Management jobs near you
Infographic showing various Medical Director Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $232,369 per year, or $111.7 per hour.

Director Utilization Mgmt

Wellpath

Lemoyne, PA • On-site

Full-time

Re-posted 5 days ago

Wellpath rating

7.2

Company rating: 7.2 out of 10

Based on 94 frontline employees who took The Breakroom Quiz

345th of 891 rated healthcare providers

Job description

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 area. They provide guidance and direction to medical staff in their efforts to ensure quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders, and works collaboratively with internal teams to optimize care delivery and achieve operational goals.


Responsibilities

  • Ensure the use of nationally recognized criteria and evidence-based standards for inpatient concurrent reviews and offsite service requests.
  • Manage UM staff including performance reviews, employee development, hiring, coaching, counseling, and retention.
  • Lead UM process improvements, facilitate patient care goals, and utilize data research to reduce length of inpatient stays and decrease ED admissions.
  • Evaluate and recommend policy improvement related to utilization review system, and provide UM updates and participate in meetings.
  • Establish and monitor progress towards UM program goals, maintain offsite service and UM tracking/reporting, and facilitate regular meetings with partner hospital clinical regarding offsite services.

Qualifications

Education

  • Medical Doctor (M.D.) or Osteopathic Doctor (D.O.) from an accredited university

Experience

  • One (1) year of experience in utilization management is required.
  • Excellent communication and organizational skills required.
  • Experience in Performance and/or Quality Improvement preferred.

Licenses/Certifications

  • Current license in state of employment to practice medicine

What Wellpath employees say

Pay

Benefits

Hours and flexibility

Workplace

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