ZipRecruiter

Log In

1

Utilization Review Director Jobs in Florida (NOW HIRING)

Fabergent

Clinical Care Reviewer

Doral, FL · On-site

ER, ICU) Experience with Utilization Review and/or Prior Authorization Familiar with Interqual ... Identifies and refers requests for services to the appropriate Medical Director when guidelines are ...

Sanitas

Palliative Medical Director (68386)

Doral, FL · On-site

... management, utilization review and quality assurance. * Collaborates in the development and ... Deliver direct patient care within the clinic scope of practice. * Perform other duties as assigned ...

previous page

Showing results 41-60

All JobsUtilization Review JobsUtilization Review Director JobsUtilization Review Director Jobs in Florida

Utilization Review Director information

See Florida salary details

$15

$31

$51

How much do utilization review director jobs pay per hour?

As of Sep 5, 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 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.

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 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 is the difference between Utilization Review Director vs Utilization Review Nurse?

AspectUtilization Review DirectorUtilization Review Nurse
CredentialsRN license, management experience, certifications (e.g., CCM)RN license, certification in case management or utilization review (e.g., CUC)
Work EnvironmentAdministrative, leadership roles overseeing teamsClinical, review of patient cases, direct patient care
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Search & Comparison IntentLeadership, management, strategic planning in utilization reviewClinical 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 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:

Utilization Review Director jobs near you

Director, Utilization Management

Independent Living Systems

Miami, FL • On-site

Full-time

Re-posted 14 days ago

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Director, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Director of Utilization Management plays an essential role in ensuring that healthcare services are delivered efficiently and effectively while maintaining high standards of member care. The Director of Utilization Management is responsible for overseeing the utilization management department, developing policies and procedures that align with regulatory requirements, and implementing best practices to optimize resource use. The Director of Utilization Management will collaborate with clinical teams to assess the appropriateness of care and ensure that members receive the right services at the right time. Additionally, the Director of Utilization Management involves analyzing data to identify trends and areas for improvement, ultimately enhancing member outcomes and satisfaction. The Director of Utilization Management will lead initiatives that promote cost-effective care while ensuring compliance with healthcare regulations and standards.

Minimum Qualifications:

  • Bachelor's degree in Nursing, Healthcare Administration, or a related field.
  • 5 years of experience in utilization management or a related healthcare field.
  • Strong knowledge of healthcare regulations, policies, and best practices.

Preferred Qualifications:

  • Master's degree in Healthcare Administration, Public Health, or a related field.
  • Certification in Utilization Management (e.g., ACM, CCM) is highly desirable.
  • Experience in a leadership role within a healthcare organization.

Responsibilities:

  • Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
  • Lead and direct a team of utilization management professionals, fostering a culture of continuous improvement and excellence.
  • Direct the daily operations of the utilization management department, ensuring compliance with all regulatory requirements.
  • Develop and implement utilization management policies and procedures that align with organizational goals.
  • Collaborate with clinical staff to review and assess the appropriateness of care provided to members.
  • Analyze utilization data to identify trends, areas for improvement, and opportunities for cost savings.
  • Ensure that assigned deliverables are completed on time, including development and coordination of required contractual and regulatory submissions.
  • Develop and track key performance indicators (KPIs) to measure organizational performance, including accurate and timely reporting of required contractual regulatory reports.
  • Develop, maintain and improve management processes, policies and procedures and/or conduct management projects including development of detailed plans to achieve project objectives.
  • Perform other duties as assigned.



What Independent Living Systems employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply