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Senior Director Utilization Management information

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$35K

$120.8K

$192K

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

As of Sep 13, 2026, the average yearly pay for senior director utilization management in the United States is $120,836.00, according to ZipRecruiter salary data. Most workers in this role earn between $75,000.00 and $156,000.00 per year, depending on experience, location, and employer.

What is a senior director utilization management?

A Senior Director of Utilization Management is a high-level healthcare executive responsible for overseeing strategies and processes that ensure patients receive appropriate, cost-effective care. They lead teams that review clinical services, manage resource utilization, and ensure compliance with healthcare regulations and quality standards. Their role often involves collaborating with physicians, case managers, and payers to optimize patient outcomes while controlling costs. They also analyze data to monitor performance and implement improvements in care delivery.

How does a senior director utilization management typically collaborate with clinical teams and other departments to achieve organizational goals?

A Senior Director of Utilization Management works closely with clinical teams, case managers, and administrative staff to ensure that care delivery is both efficient and compliant with regulatory standards. Collaboration often involves leading interdisciplinary meetings, reviewing utilization data, and developing strategies to optimize resource use while maintaining high-quality patient care. The role also requires building relationships with providers and payers to resolve complex cases and align on best practices. Effective communication and the ability to bridge clinical and operational perspectives are key to driving organizational success in this position.

What are the key skills and qualifications needed to thrive as a senior director utilization management, and why are they important?

To thrive as a Senior Director of Utilization Management, you need deep knowledge of healthcare management, utilization review, and regulatory compliance, typically backed by an advanced degree in healthcare or a related field. Experience with utilization management software, data analytics platforms, and familiarity with NCQA, CMS, or URAC standards is essential. Leadership, strategic thinking, and exceptional communication are vital soft skills for driving team performance and aligning with organizational goals. These capabilities ensure effective resource management, regulatory adherence, and optimal patient outcomes in a complex healthcare environment.

What are popular job titles related to Senior Director Utilization Management jobs?

For Senior Director Utilization Management jobs, the most frequently searched job titles are:

Infographic showing various Senior Director Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $120,836 per year, or $58.1 per hour.

Director Utilization Management MedStar Family Choice

Washington, DC • On-site

MedStar Health
Health Care and Social Assistance • 10K+ employees
Learn more about MedStar Healthexternal

$120K - $238K/yr

Full-time

Re-posted 14 days ago

Key responsibilities

  • Leads enterprise-wide utilization management strategy and ensures consistency across all health plans.

  • Oversees prior authorization, concurrent review, and retrospective review processes to ensure timely and compliant determinations.

  • Develops and monitors performance dashboards, identifies utilization trends, and implements process improvements to enhance operational efficiency.

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 242 frontline employees who took The Breakroom Quiz

Job description

About the Job
General Summary of Position
The Director of Utilization Management (UM) provides strategic and operational leadership for the health plan's centralized utilization management function across both plans. This role ensures appropriate evidence-based utilization of services while maintaining regulatory compliance improving quality outcomes and driving cost-effective delivery. Under a centralized clinical operation model the Director aligns UM process across plans standardizes workflows optimizes technology and integrates closely with Case Management Pharmacy Quality and Provider Relations to support enterprise-wide performance goals.
Primary Duties and Responsibilities
  • Leads enterprise-wide utilization management strategy across all health plans under a centralized clinical operation model.
  • Standardizes UM policies workflows and clinical criteria application to ensure consistency and scalability across markets.
  • Oversees prior authorization concurrent review retrospective review to ensure timely and compliant determinations.
  • Ensures compliance with state Medicaid NCQA CMS and contractual requirements including turnaround time standards.
  • Partners with medical directors to ensure appropriate clinical decision-making and consistent application of medical necessity criteria.
  • Develops and monitors UM performance dashboards including denial rates overturn rates length of stay and turnaround times.
  • Drives medical expense management initiatives by identifying utilization trends and implementing targeted interventions.
  • Collaborates with Case Management leadership to ensure seamless transitions between UM and care coordination functions.
  • Partners with pharmacy leadership to align utilization controls on high-cost drugs and specialty therapies.
  • Oversees hospital utilization management including inpatient admission appropriateness DRG optimization and reduction strategies.
  • Identifies and implements process improvement initiatives to increase operational efficiency and reduce variability.
  • Prepares for a lead regulatory audits accreditation reviews and corrective action plans related to UM functions.
  • Monitors and ensures compliance with evidence-based clinical criteria tools (e.g. InterQual ASAM) and internal policies.
  • Leads workforce planning and staffing models to ensure appropriate caseload distribution and productivity standards.
  • Supervises and develops UM managers and supervisors including performance evaluations and professional development.
  • Collaborates with Finance and Actuarial team to analyze utilization trends cost drivers and forecast medical expense impact.
  • Supports value-based payment models and alternative payment initiatives by aligning UM process with performance metrics.
  • Develops escalation and peer review process to manage complex or high-risk clinical determinations.
  • Ensures culturally competent and member- center decision-making balancing access quality and cost stewardship.
  • Provides executive-level reporting and strategic recommendation to the VP of Clinical Operations and senior leadership
    • Minimal Qualifications
    Education
    • Bachelor's degree Bachelor's degree in Nursing Social Work or related healthcare field required
    • Master's degree Master's degree in Nursing (MSN) Public Health (MPH) Healthcare Administration (MHA) Business Administration (MBA) or related field preferred
    Experience
    • 8-10 years years of managed care experience required and
    • 5-7 years Minimum 5 years utilization management leadership required and
    • Experience with centralized operations preferred and
    • Demonstrated experience in Medicaid managed care preferred
    Licenses and Certifications
    • RN - Registered Nurse - State Licensure and/or Compact State Licensure in MD/DC Upon Hire required
    Knowledge Skills and Abilities
    • Deep understanding of state Medicaid CMS and NCQA requirements
    • Experience in medical necessity criteria tools (InterQual)
    • Strong data analytics and financial acumen
    • Change management expertise
    • Excellent executive communication skills.

    This position has a hiring range of
    USD $120,702.00 - USD $238,222.00 /Yr.

    What Medstar Health employees say

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    About Medstar Health

    Sourced by ZipRecruiter

    MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

    Industry

    Health care and social assistance

    Company size

    10,000+ Employees

    Headquarters location

    Columbia, MD, US

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