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Medical Director Utilization Review Jobs (NOW HIRING)

Village Care

Utilization Review Nurse

Manhattan, NY · On-site

$95K - $105K/yr

RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - N ... Frequently collaborates and communicates with physician peer reviewers and medical directors in ...

UHS

Director of Utilization Review

Gulfport, MS · On-site

The Director of Utilization Review : will assume responsibility for the functioning of the ... Excellent Medical, Dental, Vision and Prescription Drug Plan * 401(K) with company match and ...

UHS

Director of Utilization Review

Gulfport, MS

The Director of Utilization Review : will assume responsibility for the functioning of the ... Excellent Medical, Dental, Vision and Prescription Drug Plan * 401(K) with company match and ...

UHS

Director of Utilization Review

Gulfport, MS · On-site

The Director of Utilization Review : will assume responsibility for the functioning of the ... Excellent Medical, Dental, Vision and Prescription Drug Plan * 401(K) with company match and ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Evaluate medical necessity, level of care, and documentation accuracy * Ensure compliance with ...

UHS

Director of Utilization Review

Gulfport, MS · On-site

The Director of Utilization Review : will assume responsibility for the functioning of the ... Excellent Medical, Dental, Vision and Prescription Drug Plan * 401(K) with company match and ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Evaluate medical necessity, level of care, and documentation accuracy * Ensure compliance with ...

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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 Jun 13, 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
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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
Utilization Review Director

Utilization Review Director

Lifepoint Health

Englewood, CO • On-site

$52 - $71/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

LifePoint Health rating

5.9

Company rating: 5.9 out of 10

Based on 258 frontline employees who took The Breakroom Quiz

748th of 872 rated healthcare providers

Job description

Job Description
Job Title: Utilization Review Director
Job Type: Onsite, Full-time
Pay rate: $52-$71 per hour
Work Schedule: Monday-Friday 8am-5pm MST
Your experience matters Denver Springs
At Denver Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.
How you'll contribute
The responsibility of the Utilization Review Director is to ensure the utilization review activities are completed accurately and timely. This includes the precertification and recertification, peer to peer process, and appeals. The UR Director will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals. The Director will ensure that all UR staff members follow department and facility procedures. The Director will further ensure that communication with all relevant departments, but especially CBO and Business Office, meets staff and patient needs. The UR Director will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals
Other Duties Include:
  • Oversees the UR department, ensuring staff has completed all assignments and monitors performance.
  • Ensures all pre-certifications are completed for inpatient and outpatient services.
  • Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the CEO or delegate.
  • Assists with creation of treatment team agenda and participates to ensure team is aware of coverage info as well as collecting information for communication with insurance or other funding source.
  • Be available to educate staff members from other relevant departments on documentation requirements / medical criteria and does so in a professional, organized, and understandable manner.
  • Works with DON to ensure documentation requirements are met.
  • Ensure appeals are completed thoroughly and on a timely basis.
  • Interface with managed care organizations, external reviews, and other payers.
  • Participates in Administrator on call rotation
  • Communicate with physicians to schedule peer to peer reviews.
  • Accurately report denials.
  • Is available to proctor staff members at other Springstone facilities on relevant policies and procedures.

What we offer
We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, PTO, medical, dental, vision, tuition reimbursement, and an Employee Assistance Program.
Qualifications and requirements
  • Education: Bachelor's degree required. Associates degree preferred.
  • Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
  • License: Current unencumbered clinical license strongly preferred. RN license preferred.
  • Additional Requirements: CPI and CPR preferred within 30 days of hire. May be required to work flexible hours.

About Us
Denver Springs hospital located in Englewood, CO, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters
EEOC Statement
"Denver Springs is an Equal Opportunity Employer. Denver Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment."
About Us
Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.
About the Team
We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.

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Benefits

Hours and flexibility

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About LifePoint Health

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Lifepoint Health serves patients, clinicians, communities and partners across the healthcare continuum. Our diversified healthcare delivery network extends from coast to coast, consisting of community hospitals, rehabilitation and behavioral health hospitals, and additional sites of care.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Brentwood, TN, US

Year founded

1999

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