Responsibilities The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios ...
Responsibilities The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios ...
Performs utilization review and management, including quality review, case review for third party ... Interpret and direct a variety of instructions furnished in written, oral, diagrammatic or schedule ...
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Performs utilization review and management, including quality review, case review for third party ... Interpret and direct a variety of instructions furnished in written, oral, diagrammatic or schedule ...
The Director of Utilization Management is also responsible for ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS. The Director: interfaces with clinical ...
The Director of Utilization Management is also responsible for ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS. The Director: interfaces with clinical ...
Utilization Review Nurse
Miami, FL · On-site
Utilization Review Nurse Job Summary The Utilization Nurse is responsible for conducting ... Coordinates peer-to-peer discussions between providers and the Medical Director as needed.
Utilization Review Nurse
Miami, FL · On-site
Utilization Review Nurse Job Summary The Utilization Nurse is responsible for conducting ... Coordinates peer-to-peer discussions between providers and the Medical Director as needed.
New Horizons is seeking an Utilization Review Specialist , who will be responsible for following up ... Escalate any potential disputes or denial of accounts to Director of Revenue or designee * Trends ...
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New Horizons is seeking an Utilization Review Specialist , who will be responsible for following up ... Escalate any potential disputes or denial of accounts to Director of Revenue or designee * Trends ...
Utilization Review RN Team Lead
Pinellas Park, FL · On-site
$81K - $122K/yr
The Team Lead collaborates with the Director of Utilization Management, supports client implementation and communication efforts, and serves as a subject matter expert in utilization review processes ...
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Utilization Review RN Team Lead
Pinellas Park, FL · On-site
$81K - $122K/yr
The Team Lead collaborates with the Director of Utilization Management, supports client implementation and communication efforts, and serves as a subject matter expert in utilization review processes ...
New
Utilization Review RN Team Lead
Pinellas Park, FL · On-site
$81K - $122K/yr
The Team Lead collaborates with the Director of Utilization Management, supports client implementation and communication efforts, and serves as a subject matter expert in utilization review processes ...
New
Utilization Review RN Team Lead
Pinellas Park, FL · On-site
$81K - $122K/yr
The Team Lead collaborates with the Director of Utilization Management, supports client implementation and communication efforts, and serves as a subject matter expert in utilization review processes ...
New
Utilization Review/Outpatient Care RN
Tampa, FL · On-site
$28 - $32/hr
Utilization Review/Outpatient Care RN Are you an experienced Registered Nurse with Utilization ... Initiates and continues direct communication with health care providers involved with the care of ...
Utilization Review/Outpatient Care RN
Tampa, FL · On-site
$28 - $32/hr
Utilization Review/Outpatient Care RN Are you an experienced Registered Nurse with Utilization ... Initiates and continues direct communication with health care providers involved with the care of ...
Utilization Review RN Team Lead
Pinellas Park, FL · On-site
$81K - $122K/yr
The Team Lead collaborates with the Director of Utilization Management, supports client implementation and communication efforts, and serves as a subject matter expert in utilization review processes ...
New
Utilization Review RN Team Lead
Pinellas Park, FL · On-site
$81K - $122K/yr
The Team Lead collaborates with the Director of Utilization Management, supports client implementation and communication efforts, and serves as a subject matter expert in utilization review processes ...
New
Utilization Review Specialist (RN) - Remote
Jacksonville, FL · On-site
$65K - $85K/yr
Utilization Review Specialist (RN) - Remote $65K-$85K | OASIS & Coding Certified | Florida RN ... Collaborate with Branch Directors, Clinical Managers, and field clinicians * Support quality ...
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Utilization Review Specialist (RN) - Remote
Jacksonville, FL · On-site
$65K - $85K/yr
Utilization Review Specialist (RN) - Remote $65K-$85K | OASIS & Coding Certified | Florida RN ... Collaborate with Branch Directors, Clinical Managers, and field clinicians * Support quality ...
Utilization Review RN Team Lead
Pinellas Park, FL · On-site
$81K - $122K/yr
The Team Lead collaborates with the Director of Utilization Management, supports client implementation and communication efforts, and serves as a subject matter expert in utilization review processes ...
Utilization Review RN Team Lead
Pinellas Park, FL · On-site
$81K - $122K/yr
The Team Lead collaborates with the Director of Utilization Management, supports client implementation and communication efforts, and serves as a subject matter expert in utilization review processes ...
HEDIS Utilization Review Nurse
Winter Haven, FL · On-site
$26.50 - $35/hr
Director of Managed Care FLSA Status: Exempt Personnel Supervised: None POSITION SUMMARY: The HEDIS Utilization Review Specialist is responsible for performing comprehensive reviews of medical ...
HEDIS Utilization Review Nurse
Winter Haven, FL · On-site
$26.50 - $35/hr
Director of Managed Care FLSA Status: Exempt Personnel Supervised: None POSITION SUMMARY: The HEDIS Utilization Review Specialist is responsible for performing comprehensive reviews of medical ...
Utilization Review Specialist (in-office only)
Boca Raton, FL · On-site
$55K - $70K/yr
We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL Compensation: $55,000 ... UR Specialists serve as the direct liaison between facility clinical teams, insurance providers ...
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Utilization Review Specialist (in-office only)
Boca Raton, FL · On-site
$55K - $70K/yr
We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL Compensation: $55,000 ... UR Specialists serve as the direct liaison between facility clinical teams, insurance providers ...
Utilization Review Specialist (in-office only)
Boca Raton, FL · On-site
$55K - $70K/yr
We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL Compensation: $55,000 ... UR Specialists serve as the direct liaison between facility clinical teams, insurance providers ...
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Utilization Review Specialist (in-office only)
Boca Raton, FL · On-site
$55K - $70K/yr
We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL Compensation: $55,000 ... UR Specialists serve as the direct liaison between facility clinical teams, insurance providers ...
Remote Utilization Review RN (Hospital-Based Experience Required)
Fort Lauderdale, FL · Remote
$80K - $105K/yr
Setting: Fully Remote - Utilization Review Schedule: Full-Time, Monday-Friday Hours: Standard ... Direct access to hiring decision-makers * Timely feedback throughout the interview process
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Remote Utilization Review RN (Hospital-Based Experience Required)
Fort Lauderdale, FL · Remote
$80K - $105K/yr
Setting: Fully Remote - Utilization Review Schedule: Full-Time, Monday-Friday Hours: Standard ... Direct access to hiring decision-makers * Timely feedback throughout the interview process
Physician Reviewer - Utilization Management
Orlando, FL · Remote
$219K/yr
... Medical Director, Utilization Management. Work Location: This is a remote position, open to ... Receive and review escalated reviews. * Conduct timely peer-to-peer discussions with treating ...
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Physician Reviewer - Utilization Management
Orlando, FL · Remote
$219K/yr
... Medical Director, Utilization Management. Work Location: This is a remote position, open to ... Receive and review escalated reviews. * Conduct timely peer-to-peer discussions with treating ...
New
... the Director, is responsible for department coordination of utilization, other review activities to ensure payment for services is authorized and an active and effective utilization management ...
... the Director, is responsible for department coordination of utilization, other review activities to ensure payment for services is authorized and an active and effective utilization management ...
The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical ...
The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical ...
... the Director, is responsible for department coordination of utilization, other review activities to ensure payment for services is authorized and an active and effective utilization management ...
... the Director, is responsible for department coordination of utilization, other review activities to ensure payment for services is authorized and an active and effective utilization management ...
The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical ...
The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical ...
Utilization Review Director information
See Florida salary details
$15.99 - $19.22
2% of jobs
$19.22 - $22.45
9% of jobs
$24.67 is the 25th percentile. Wages below this are outliers.
$22.45 - $25.69
21% of jobs
The median wage is $28.31 / hr.
$25.69 - $28.92
23% of jobs
$28.92 - $32.16
13% of jobs
$34.67 is the 75th percentile. Wages above this are outliers.
$32.16 - $35.39
10% of jobs
$35.39 - $38.62
8% of jobs
$38.62 - $41.86
5% of jobs
$41.86 - $45.09
5% of jobs
$45.09 - $48.32
2% of jobs
$48.32 - $51.56
2% of jobs
$15
$31
$51
How much do utilization review director jobs pay per hour?
As of Aug 11, 2026, the average hourly pay for utilization review director in Florida is $31.60, according to ZipRecruiter salary data. Most workers in this role earn between $24.95 and $36.30 per hour, depending on experience, location, and employer.
What is the difference between Utilization Review Director vs Utilization Review Nurse?
| Aspect | Utilization Review Director | Utilization Review Nurse |
|---|---|---|
| Credentials | RN license, management experience, certifications (e.g., CCM) | RN license, certification in case management or utilization review (e.g., CUC) |
| Work Environment | Administrative, leadership roles overseeing teams | Clinical, review of patient cases, direct patient care |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare providers |
| Search & Comparison Intent | Leadership, management, strategic planning in utilization review | Clinical review, case assessment, patient care coordination |
The Utilization Review Director typically oversees review teams and manages utilization strategies, requiring leadership skills and management experience. In contrast, the Utilization Review Nurse focuses on clinical case assessments and patient care reviews. Both roles require RN licensure and relevant certifications but differ mainly in scope and responsibilities.
What does a utilization review director do?
A Utilization Review Director oversees the evaluation of medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead teams that review patient care requests, manage compliance with regulations, and implement strategies to ensure cost-effective care without compromising quality. Their responsibilities often include policy development, data analysis, and collaboration with healthcare providers to optimize resource use and improve patient outcomes.
Is utilization review a stressful job?
Utilization Review Directors often work in high-pressure environments where they must make quick, accurate decisions regarding healthcare services. The role can be stressful due to the need to balance patient care, insurance policies, and regulatory compliance, but stress levels vary based on workload, organizational support, and experience. Strong analytical skills and certification in utilization review can help manage job demands effectively.
What degree do I need for utilization review director?
A utilization review director typically needs at least a bachelor's degree in healthcare administration, nursing, or a related field. Many employers prefer candidates with a master's degree such as an MBA or a healthcare-related advanced degree, along with relevant experience and certifications like the Certified Professional in Healthcare Quality (CPHQ).
What are some common challenges faced by a utilization review director, and how can they be addressed?
A Utilization Review Director often navigates challenges such as balancing regulatory compliance with organizational goals, managing interdisciplinary teams, and keeping up with evolving healthcare policies. Staying proactive with ongoing education, fostering open communication among staff, and implementing efficient review processes can help address these issues. Additionally, leveraging data analytics and technology streamlines case reviews and ensures evidence-based decision-making, ultimately improving both patient outcomes and operational efficiency.
What are the key skills and qualifications needed to thrive as a utilization review director, and why are they important?
To thrive as a Utilization Review Director, you need a deep understanding of clinical guidelines, healthcare regulations, and case management principles, typically supported by a nursing or related healthcare degree and relevant licensure. Familiarity with utilization management software, electronic health records (EHR), and certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) is common in the field. Strong leadership, communication, analytical thinking, and decision-making skills help you effectively manage teams and ensure compliance. These competencies ensure efficient resource use, regulatory adherence, and high-quality patient outcomes within healthcare organizations.
What are the most commonly searched types of Utilization Review jobs in Florida? The most popular types of Utilization Review jobs in Florida are:
What cities in Florida are hiring for Utilization Review Director jobs? Cities in Florida with the most Utilization Review Director job openings:
Universal Health Services rating
6.8
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
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
What Universal Health Services employees say
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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