ZipRecruiter

Log In

1

Utilization Review Director Jobs in Ohio (NOW HIRING)

Holzer Health System

Lead Case Manager

Gallipolis, OH · On-site

Works under the supervision of the Director of Care Management. Supervises case managers on a day ... Serves as a clinical expert and resource in Utilization Review and Case Management. Refers ...

Molina Healthcare

Medical Review Nurse (RN)

Columbus, OH · On-site

$29.05 - $56.64/hr

... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... criteria with medical directors on denial decisions. • Supplies criteria supporting all ...

Molina Healthcare

Medical Review Nurse (RN)

Columbus, OH · Remote

$29.05 - $56.64/hr

... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... criteria with medical directors on denial decisions. • Supplies criteria supporting all ...

previous pagenext page

Showing results 21-40

All JobsUtilization Review JobsUtilization Review Director JobsUtilization Review Director Jobs in Ohio

Utilization Review Director information

See Ohio salary details

$20

$40

$65

How much do utilization review director jobs pay per hour?

As of Aug 12, 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 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 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 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

Utilization Management (UM) Coordinator

Communicarehealth

Blue Ash, OH • On-site

$27 - $34/hr

Full-time

Re-posted 20 days ago

Job description

Job Address:

10123 Alliance Road, Suite 320 Blue Ash, OH 45242


Kids Thrive is currently recruiting a Utilization Management (UM) Coordinator to join our team!

Position Summary:

The UM Coordinator works with the Director of UM by providing the precertification and recertification process, peer to peer reviews, and appeal. The UM Coordinator will ensure an appropriate discharge plan is in place for each patient discharge. The UM Coordinator will accurately report the authorization, denials, and appeals status of patients to the UM Director. They follow department and facility procedures and ensure effective communication with all relevant departments regarding patient care needs.

Estimated Pay Range: $27-34/hr

Job Duties:

  • Responds to the request for services including the determination of appropriate level of care, initial authorization, the concurrent review process, and appropriate discharge planning.
  • Reviews the quality of documentation for each level of care to ensure clinical effectiveness and appropriateness of treatment.
  • Participates in clinical team review and evaluation of services offered at the facility to ensure goals and objectives are consistent throughout programs and facility expectations.
  • Meets regularly with the UM Director to ensure compliance with program goals and objectives.
  • Maintains an active involvement and awareness of all patient admissions, discharges and transfers to alternate levels of care. Works towards continuity of care for each level of care transition.
  • Provides assistance with the coordination with managed care companies or other third-party payors regarding peer reviews, retrospective reviews and appeals. Documents and updates the denial log to reflect same.
  • Maintains logs of all certifications and denials along with updated status of same.
  • Maintains processes to minimize denials and communication of same to the CFO and Business Office Manager.
  • Reviews benefit verifications and updates for level of care benefits with the Business Office to ensure and optimize maximum patient care and treatment.
  • Ensures processes are followed to provide adequate continuity of care and communication to families/support systems as well as referral sources for treatment and aftercare planning.
  • Reports results of daily treatment team meetings all discharges and status of high risk cases such as limited benefits, peer reviews, denials, or unplanned discharges.
  • Strong working knowledge of external review organizations (ie: Medicare/Managed Care/Medicaid) with knowledge of payor resources and planning.
  • Ability to state local laws, ordinances, and practices governing involuntary hospitalization and ensure compliance with same.
  • Demonstrates an ability to be flexible, organized, and function well in stressful situations.
  • Interacts professionally with patient/family and provides explanations and verbal reassurance as necessary.
  • Maintains a good working relationship/team work both within the department and with other departments.
  • Ensures that documentation meets current standards and policies.
  • Manages and operates equipment safely and correctly.
  • Supports and maintains a culture of safety and quality.
  • Demonstrates understanding of HIPAA.
  • Demonstrates understanding of Patient Rights and Patient's Right to Report and Patient Advocacy.

Qualifications:

  • Education: Bachelor's Degree in Nursing, Social Work, Mental Health/Behavioral Sciencespreferred.
  • Experience:Directclinical experience in a psychiatric or mental health treatment setting, including managing a related function preferred. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
  • License: LPN, RN, LMSW, LPC or applicable license preferred.
  • Additional Requirements:CPRcertification andHandle with Care training within30 daysof employment.May berequiredto work flexible hours and overtimeincluding evenings, weekends, and holidays.All certifications are to bemaintainedduring tenure of employment.

Apply