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Medical Director Utilization Review Jobs (NOW HIRING)

UHS

DIR - UTILIZATION REVIEW / MGMT

Jacksonville, FL · On-site

Responsibilities The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios ...

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How much do medical director utilization review jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for medical director utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What does a medical director utilization review do?

A Medical Director of Utilization Review oversees the process of evaluating the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. They work with clinical teams, insurance companies, and care providers to ensure treatments and hospital stays are justified and align with best practices and guidelines. Their role helps manage healthcare costs, improve patient outcomes, and ensure compliance with regulations. Additionally, they may review cases, provide clinical guidance, and participate in developing utilization policies.

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

To thrive as a Medical Director Utilization Review, you need a strong clinical background, active medical licensure, and substantial experience in utilization management or healthcare administration. Familiarity with utilization review software, health plan guidelines, and regulatory standards such as CMS and NCQA is crucial. Excellent analytical thinking, decision-making, and communication skills distinguish top performers in this role. These competencies ensure accurate, compliant, and efficient medical necessity reviews that support both patient care and organizational objectives.

What are some common challenges faced by a medical director utilization review, and how can they be managed effectively?

Medical Directors in Utilization Review often encounter challenges such as balancing clinical guidelines with the administrative demands of insurance policies, managing high caseloads, and ensuring timely decision-making. These professionals must navigate potential conflicts between providers and payers while maintaining patient advocacy and regulatory compliance. Effective management includes staying current with clinical best practices, fostering strong communication with multidisciplinary teams, and utilizing data-driven approaches to support fair and efficient utilization decisions.

What is the difference between Medical Director Utilization Review vs Medical Reviewer?

AspectMedical Director Utilization ReviewMedical Reviewer
CredentialsMedical degree, state medical license, often board-certified in a specialty, and utilization review certificationMedical degree, state medical license, and often utilization review certification
Work EnvironmentAdministrative setting, insurance companies, or healthcare organizations overseeing utilization policiesClinical setting, reviewing individual cases, often employed by insurance or healthcare providers
Employer & IndustryInsurance companies, healthcare organizations, managed care plans

While both roles require medical credentials and involve utilization review, the Medical Director Utilization Review typically holds a leadership position overseeing policies and compliance, whereas the Medical Reviewer focuses on case-by-case assessments. The Director role involves strategic oversight, while the Reviewer handles individual case evaluations.

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Medical Director Utilization Review jobs near you
Infographic showing various Medical Director Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Medical Director (Contract)

Integra Partners

Troy, MI • Remote

$150/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Job description

The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra’s Utilization Management (UM) operations. Role functions within a structured, high-volume authorization review queue and requires adherence to workflow timelines, clinical accuracy standards, and productivity expectations. The Medical Director ensures determinations are made in accordance with Medicare and Medicaid guidelines, health plan–specific criteria, internal policies, and regulatory requirements. This role is best suited for physicians who thrive in a process-driven environment and are committed to consistency, compliance, and evidence-based decision making.
The Utilization Review Medical Director’s responsibilities include but are not limited to:
  • Conduct timely clinical reviews of DMEPOS authorization requests using applicable criteria, including LCDs, Medicaid Manuals, InterQual, MCG, internal medical policies, and health plan requirements.
  • Function within a real-time review queue and maintain continuous case throughput in alignment with organizational turnaround and productivity standards.
  • Evaluate clinical documentation, identify missing elements, and render determinations supported by clear clinical rationale.
  • Review cases escalated by UM staff and/or UM Leadership when criteria do not apply to the enrollee’s unique clinical situation or when clinical judgment is required.
  • When appropriate, consult with external board-certified reviewers, engage with ordering practitioners, or conduct additional clinical dialogue prior to rendering a determination.
  • Participate in Peer-to-Peer (P2P) discussions, including maintaining availability for scheduled appointment times.
  • Document all clinical decisions clearly, concisely, and consistently in accordance with internal SOPs, NCQA standards, and regulatory expectations.
  • Maintain inter-rater reliability and participate in periodic calibration reviews to support consistency across the UM program.
  • Serve as a clinical resource for UM team, providing guidance on clinical interpretation, criteria application, and complex case review.
  • Support internal and external audit activities as needed, including NCQA accreditation, health plan audits, and state Medicaid reviews.
  • Notify leadership of observed trends, potential quality concerns, or opportunities to strengthen criteria alignment or operational workflows.
  • Maintain up-to-date knowledge of Medicare, Medicaid, DMEPOS policies, clinical standards of care, and regulatory updates relevant to UM.
 Requirements:
  • MD or DO degree
  • Board certification in Internal Medicine, Family Medicine, or Physical Medicine & Rehabilitation
  • Eligible for participation in Medicare, Medicaid, and other federally funded programs; no current or past OIG or state sanctions
  • Experience performing utilization management or clinical review activities
  • Strong written and verbal communication skills with emphasis on documentation accuracy
  • Ability to work effectively in a high-volume, queue-based workflow with daily review expectations
  • Familiarity with electronic UM systems and authorization platforms
  • Experience with DMEPOS reviews
  • Experience with NCQA UM accreditation standards
  • Prior UM experience for MLTC, Medicaid, or Medicare Advantage plans
 Working Conditions and Additional Expectations:
  • Remote role requiring consistent availability during standard business hours and responsiveness to daily assignments.
  • Case volume and mix vary; continuous throughput and timely review completion are required.
  • Must maintain a quiet, secure, and compliant environment for reviewing PHI and participating in P2P calls.
  • Secondary employment or consulting arrangements are permitted only if they do not interfere with the full-time expectations and require disclosure/approval.
  • Daily accountability measures, productivity monitoring, and adherence to all UM workflows are required.
Salary: $150.00/Hourly 
 

Benefits Offered

  • Competitive compensation and annual bonus program
  • 401(k) retirement program with company match
  • Company-paid life insurance
  • Company-paid short term disability coverage (location restrictions may apply)
  • Medical, Vision, and Dental benefits
  • Paid Time Off (PTO)
  • Paid Parental Leave
  • Sick Time
  • Paid company holidays and floating holidays
  • Quarterly company-sponsored events
  • Health and wellness programs
  • Career development opportunities

Remote Opportunities

We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.

Our Story

Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits.

With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.

Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.

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