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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 Aug 15, 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?

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 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.
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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 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

DIR - UTILIZATION REVIEW / MGMT

UHS

Jacksonville, FL • On-site

Full-time

Re-posted 8 days ago

Universal Health Services rating

6.8

Company rating: 6.8 out of 10

Based on 253 frontline employees who took The Breakroom Quiz

493rd of 887 rated healthcare providers

Job description

Responsibilities
The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients, oversees the response to requests for services and interfaces with managed care organization, external reviewers, and other payers.
Directly supervises a minimum of 5 staff. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems
Must be a Registered Nurse, and/or have a Bachelor's Degree in Social Work or Psychology or equivalent education and experience in Utilization Review/ Management. Has knowledge of regulatory and reimbursement requirements. Able to monitor and evaluate records for quality and appropriateness of care. Able to work independently and collegially with all clinical disciplines and staff within the hospital. Demonstrates leadership ability, good communication skills, ability to delegate and supervise.
Ability to read, analyze, and interpret common scientific and technical journals, financial reports and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies or members of the business community. Ability to write speeches and articles for publication that conform to prescribed style and format. Ability to effectively present information to top management, public groups, and/or boards of directors.
Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
While performing the duties of this job, the employee is regularly required to stand, walk, and site; use hands to finger, handle, or feel, reach with hands and arms, stoop, kneel, crouch, or crawl.
The employee must regularly lift and/or move up to 25 pounds, and occasionally up to 75 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.
Qualifications
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 300 corporation, annual revenues were $15.8 billion in 2024. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies.
Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

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About Universal Health Services

Sourced by ZipRecruiter

Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

King of Prussia, PA, US

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