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Medical Director Utilization Review information

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

As of Jul 4, 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 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.

What are the key skills and qualifications needed to thrive as a Medical Director Utilization Review, and why are they important?

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 in 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 does a Medical Director of 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.
More about Medical Director Utilization Review jobs
What cities are hiring for Medical Director Utilization Review jobs? Cities with the most Medical Director Utilization Review job openings:
What states have the most Medical Director Utilization Review jobs? States with the most job openings for Medical Director Utilization Review jobs include:
What job categories do people searching Medical Director Utilization Review jobs look for? The top searched job categories for Medical Director Utilization Review jobs are:
Medical Director Utilization Review jobs near you

Group Director - Utilization Review

Detroit Medical Center Shared Services

Detroit, MI • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

Job description

Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At The Detroit Medical Center (DMC), we're seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.
Benefit Statement
At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That's why we offer more than a job - we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:
• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off (PTO)
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness
insurance, long term care, elder & childcare, auto & home insurance.
Note: Eligibility for benefits may vary by location and is determined by employment status
Summary:
The Group Director, Utilization Review will perform the functions necessary to support and advance Tenet's Case Management strategy with the specific focus on Utilization Review for the designated Market. Will support the advancement of Centralized Utilization Review as a leader, mentor, and consultant. Will execute on strategic initiatives and will provide subject matter expertise for Case Management - Utilization Review regulations and standards, including ensuring compliance with all state and federal regulations.
POSITION SPECIFIC RESPONSIBILITIES:
The Group Director will be responsible for developing and maintaining procedure manuals for such activities as: UM annual work plan/evaluation and quarterly and semi-annual UM reports; oversight of daily operations of the UM team and optimizing denial mitigation processes.
Will partner with the Group DCM and Hospital Case Mgt. Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction. Will ensure effective utilization of resources, timely and accurate revenue cycle processes, denial prevention, and safe and timely patient throughput. Will integrate national standards for utilization management supporting medical necessity and denials prevention.
Qualifications:
QUALIFICATIONS:
• Bachelor's degree in business, nursing or health care administration required. Advanced degree in business, nursing and/or healthcare administration, health science or related discipline preferred.
• A minimum of 5 years' experience in hospital revenue cycle function. Five (5) years in hospital Utilization Review Leadership preferred. Multi-site leadership experience preferred. Experience successfully implementing centralized Utilization Review teams for multi-hospital system strongly preferred. Working knowledge of CarePort and MIDAS documentation and reporting required. Project Management and Business Planning experience; strong analytical skills including use of Tableau and Excel; executive communication and presentation skills including ability to use PowerPoint.
• Accredited Case Manager (ACM) or Certified Public Accountant (CPA) preferred, Six Sigma Green Belt preferred
• Valid Registered Nurse (RN) preferred
PHYSICAL DEMANDS:
-Lift/position up to 25 lbs. Push/pull up to 25 lbs of force.
-Frequent sitting. Moderate standing, walking, reaching, stooping, and bending
-Manual dexterity, mobility, touch, auditory to perform all the related duties of the position
Facility Description
The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients and families throughout Michigan and beyond. A premier healthcare resource, our mission is to help people live happier, healthier lives. The hospitals of the Detroit Medical Center are the Children's Hospital of Michigan, Detroit Receiving Hospital, Harper University Hospital, Hutzel Women's Hospital, the DMC Heart Hospital, Huron Valley-Sinai Hospital, the Rehabilitation Institute of Michigan and Sinai-Grace Hospital.
DMC's 150-year legacy of medical excellence and service provides patients and families world-class care in cardiovascular health, women's services, neurosciences, stroke treatment, orthopedics, pediatrics, rehabilitation, organ transplant and other general and specialty services.
DMC is a key partner in Detroit's resurgence, which continues to draw national and international attention. A dedicated corporate citizen with strong community ties, DMC is one of the largest and most diverse employers in Southeast Michigan.
EEO Statement
Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other 13 legally protected status.
Tenet will make reasonable accommodation for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.
E-Verify: http://www.uscis.gov/e-verify
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations

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