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Utilization Review Director Jobs in Hawaii (NOW HIRING)

AlohaCare

Medical Director

Honolulu, HI · On-site

$151.54 - $185.98/hr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Director, Behavioral Health in planning and establishing goals and policies to improve ...

AlohaCare

Medical Director

Honolulu, HI · On-site

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Director, Behavioral Health in planning and establishing goals and policies to improve ...

AlohaCare

Medical Director

Honolulu, HI · On-site

$110 - $135/hr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Director, Behavioral Health in planning and establishing goals and policies to improve ...

AlohaCare

Medical Director

Honolulu, HI

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Director, Behavioral Health in planning and establishing goals and policies to improve ...

AlohaCare

Medical Director

Honolulu, HI · On-site

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Director, Behavioral Health in planning and establishing goals and policies to improve ...

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All JobsUtilization Review JobsUtilization Review Director JobsUtilization Review Director Jobs in Hawaii

Utilization Review Director information

See Hawaii salary details

$22

$43

$71

How much do utilization review director jobs pay per hour?

As of Aug 25, 2026, the average hourly pay for utilization review director in Hawaii is $43.93, according to ZipRecruiter salary data. Most workers in this role earn between $34.71 and $50.43 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 Hawaii?

The most popular types of Utilization Review jobs in Hawaii are:

Utilization Review Director jobs near you

Concurrent Nurse Reviewer - Facility Utilization Review Unit

HMSA

Honolulu, HI • On-site

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

  1. Applies appropriate medical necessity criteria from established medical policies and clinical practice guidelines to apply concurrent review determinations as described in the Medical Management UM work plan.
    • This detailed clinical judgment includes determination of inpatient hospital stays as medically appropriate for the member's clinical condition or whether the stay requires referral to a Medical Director for potential denial.
    • The Nurse Reviewer must follow each line of business requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each inpatient admission.
    • Responsibilities include using effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to:
      • Promote improved quality of care and/or life
      • Promote cost effective medical outcomes
      • Prevent hospitalization when possible and appropriate
      • Promote decreased lengths of hospital stays when appropriate
      • Ensure the quality-of-care member is receiving during hospital stay is appropriate
      • Ensure appropriate levels of care are received by patients
      • Consult with Medical Directors on potential quality issues encountered during review of medical records in situations when the complexity of the member's medical, surgical and/or pharmaceutical management is unclear and may require further review or intervention and follow up with attending physicians, hospitalists, or other facility staff
  2. Provide appropriate consultation and referral to Case Management or QUEST Integration program as appropriate
  3. Identify appropriate alternative and non-traditional resources and demonstrate creativity in managing each case to fully utilize all available inpatient and community resources.
  4. Identifies cost savings and accurately records all communications and interventions.
  5. Evaluates suspended claims against medical records to determine the medical necessity and appropriateness of medical services, identify irregularities such as over or under-utilization of services, potential up-coding, over billing, etc.
  6. Communicates timely, accurate information either verbally or in writing using clinical judgment, knowledge of medical/reimbursement policies and plan benefits to internal MM staff, other internal departments (Claims Administration, Customer Relations, etc.), providers, members, and other authorized persons.
    • For denied services, ensures the denial, benefit and appeal language are accurate and consistent with department procedures, accreditation, and regulatory guidelines.
  7. Identifies and refers members with specific medical and/or behavioral health needs or complex case management and collaborates with case management staff as needed. Also identifies and refers quality of care issues and suspected fraud, waste, or abuse to the appropriate departments.
  8. Performs all other miscellaneous responsibilities and duties as assigned or directed.
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