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Utilization Review Director Jobs in Ohio (NOW HIRING)

Sevita

Utilization Review Specialist

Akron, OH · On-site

$40K/yr

SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... May direct and supervise clerical and administrative staff * Provides feedback on performance ...

Nationwide Children's Hospital

Conducts utilization reviews of behavioral health cases to determine medical necessity ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"

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Utilization Review Director information

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$40

$65

How much do utilization review director jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for utilization review director in Ohio is $40.20, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $46.15 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 Ohio?

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

What cities in Ohio are hiring for Utilization Review Director jobs?

Cities in Ohio with the most Utilization Review Director job openings:

Utilization Review Director jobs near you

Director of Utilization Review

New Vista Behavioral Health

Cincinnati, OH • On-site

$78K - $100K/yr

Full-time

Posted 16 hours ago

Posted today

Job description

Corporate Director of Utilization Review

New Vista Behavioral Health

Pay Range: $78k - $100k per year
Schedule: Full Time
Location: Blue Ash, OH

New Vista Behavioral Health is seeking an experienced Corporate Director of Utilization Review to provide strategic leadership and oversight of utilization review and utilization management across our behavioral health organization.

This is a high-impact corporate leadership role responsible for ensuring clinically appropriate, timely, and financially responsible utilization of behavioral health services. The Director will partner with clinical, medical, operations, revenue cycle, quality, compliance, admissions, discharge planning, and payer relations teams to optimize authorizations, reduce avoidable denials, support appropriate length of stay, and promote timely transitions of care.

Key Responsibilities
  • Lead and oversee the organization’s enterprise-wide Utilization Review program and establish consistent best practices across facilities and programs.
  • Develop and implement standardized UR policies, workflows, performance expectations, and quality metrics.
  • Oversee initial, concurrent, continued-stay, retrospective, and discharge-related utilization reviews.
  • Ensure timely and accurate submission of clinical information and authorization requests to managed care organizations and other payers.
  • Monitor authorization outcomes, denials, length of stay, continued-stay days, and other utilization trends.
  • Develop strategies to prevent avoidable denials and improve payer authorization and appeal outcomes.
  • Oversee peer-to-peer reviews, clinical escalations, and medical necessity appeals.
  • Partner with clinical leadership to ensure documentation supports medical necessity, level of care, treatment needs, and continued stay.
  • Establish and monitor corporate UR dashboards and key performance indicators.
  • Identify trends and opportunities for operational, clinical, and financial improvement.
  • Provide coaching, mentoring, and leadership to facility-level UR teams and managers.
  • Collaborate with Revenue Cycle, Payer Relations, Quality, Compliance, Medical Staff, and Operations to resolve utilization and reimbursement challenges.
  • Maintain compliance with applicable regulatory, accreditation, payer, and organizational requirements.
  • Serve as the organization’s subject-matter expert on behavioral health utilization management and medical necessity.
Qualifications
  • Bachelor’s degree in Nursing, Healthcare Administration, Social Work, Psychology, or a related healthcare field required.
  • Master’s degree preferred.
  • Active clinical license or applicable professional credential preferred.
  • 7+ years of progressive healthcare experience, including significant behavioral health utilization review/management experience.
  • 3–5+ years of leadership experience, preferably in a multi-site or corporate healthcare environment.
  • Strong knowledge of behavioral health levels of care, medical necessity, payer authorization, concurrent review, denials, peer-to-peer reviews, and appeals.
  • Demonstrated success improving authorization outcomes and reducing avoidable denials.
  • Strong analytical, organizational, communication, and leadership skills.
  • Experience with behavioral health EHRs, payer portals, and utilization management systems preferred.
  • Knowledge of InterQual, MCG, ASAM, LOCUS, or other applicable clinical criteria is a plus.

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