This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
MDS Solutions - Senior Director of Operations
Madison, WI · On-site
$150 - $190/hr
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
MDS Solutions - Senior Director of Operations
Madison, WI · On-site
$150 - $190/hr
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...
... review, and team-building * Assist with delivery of new employee orientation programs for team ... Provide team members with ongoing and consistent feedback, directed toward clinical excellence and ...
... review, and team-building * Assist with delivery of new employee orientation programs for team ... Provide team members with ongoing and consistent feedback, directed toward clinical excellence and ...
... review, and team-building * Assist with delivery of new employee orientation programs for team ... Provide team members with ongoing and consistent feedback, directed toward clinical excellence and ...
... review, and team-building * Assist with delivery of new employee orientation programs for team ... Provide team members with ongoing and consistent feedback, directed toward clinical excellence and ...
... review, and team-building * Assist with delivery of new employee orientation programs for team ... Provide team members with ongoing and consistent feedback, directed toward clinical excellence and ...
... review, and team-building * Assist with delivery of new employee orientation programs for team ... Provide team members with ongoing and consistent feedback, directed toward clinical excellence and ...
Medical Director - Cardiovascular Service Line
Glendale, WI · On-site
$300 - $400/hr
Plan and direct medical policies and programs. * Dyad leadership model * Oversight of a well ... Implement utilization review and quality improvement systems. Implement educational programs and ...
Medical Director - Cardiovascular Service Line
Glendale, WI · On-site
$300 - $400/hr
Plan and direct medical policies and programs. * Dyad leadership model * Oversight of a well ... Implement utilization review and quality improvement systems. Implement educational programs and ...
Region Director Care Coordination-Central Region
South Milwaukee, WI · Remote
$69.41 - $103.25/hr
Collaborates with the System and Region Director(s) of Utilization Management to ensure cohesive workflows between care management and utilization review; Applies strategies within daily operations ...
Region Director Care Coordination-Central Region
South Milwaukee, WI · Remote
$69.41 - $103.25/hr
Collaborates with the System and Region Director(s) of Utilization Management to ensure cohesive workflows between care management and utilization review; Applies strategies within daily operations ...
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Utilization Review Director information
See Wisconsin salary details
$21.59 - $25.96
2% of jobs
$25.96 - $30.33
9% of jobs
$33.32 is the 25th percentile. Wages below this are outliers.
$30.33 - $34.70
21% of jobs
The median wage is $38.23 / hr.
$34.70 - $39.06
23% of jobs
$39.06 - $43.43
13% of jobs
$46.83 is the 75th percentile. Wages above this are outliers.
$43.43 - $47.80
10% of jobs
$47.80 - $52.17
8% of jobs
$52.17 - $56.53
5% of jobs
$56.53 - $60.90
5% of jobs
$60.90 - $65.27
2% of jobs
$65.27 - $69.64
2% of jobs
$21
$42
$69
How much do utilization review director jobs pay per hour?
As of Aug 11, 2026, the average hourly pay for utilization review director in Wisconsin is $42.68, according to ZipRecruiter salary data. Most workers in this role earn between $33.75 and $48.99 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 Wisconsin? The most popular types of Utilization Review jobs in Wisconsin are:
What cities in Wisconsin are hiring for Utilization Review Director jobs? Cities in Wisconsin with the most Utilization Review Director job openings:
Full-time
Medical, Dental, Life, Retirement, PTO
Posted 8 days ago
Job description
Overview
MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS division as a full-time Senior Director of Operations.
Education:
• Required: Graduate of an accredited college or university with a bachelor's in nursing
Experience:
• Required: At least 5 years of clinical experience, with 3 or more years of experience with the RAI process
Licenses/Certificates:
• Required: Current and unrestricted RN license in state(s) assigned
• Required: RAC-CT certification upon hire or within 6 months of hire.
• Required: Valid driver license and car insurance as required by state law.
• Required: Other as required by federal, state and local standards
Other Requirements:
• Proficient knowledge of PDPM and State Case Mix Reimbursement payment systems.
• Proficient in CMS Five Star Quality Measures, and Quality RFeporting Program
• Strong knowledge in current Medicare and Managed Care requirements and federal, state, and local regulations that affect skilled clinical care delivery.
• Ability to work effectively with all persons and disciplines.
• Ability to clearly articulate the complexities of RAI assessments and care planning.
• Ability to monitor MDS Coordinators and CRS's to identify areas for growth and provide mentorship for growth, while maintaining accountability for standard operating
procedures and client outcomes.
• Must possess strong customer service skills to coordinate service delivery, including attention to clients, sensitivity to issues, identification and resolution of issues to promote positive client outcomes. Initiative, innovation,
and creativity required.
• Must have dynamic presentation skills and superior communication skills.
• Must have critical thinking skills with the ability to make good decisions and exercise sound clinical and professional judgment, with proven knowledge of quality
improvement concepts and processes.
Responsibilities
The Senior Director of Operations provides leadership and oversight to assigned Directors, MDS Coordinators and Clinical Reimbursement Specialists while partnering with facility leadership to drive reimbursement optimization, quality improvement, regulatory compliance, and operational excellence. The role combines direct consulting services with leadership responsibilities to ensure clients achieve measurable and sustainable results.
The Senior Director serves as a strategic partner to clients by identifying opportunities for improvement, developing action plans, providing education, and ensuring consulting recommendations translate into sustainable results. This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
Qualifications
About Us:
At Key Rehab, we're shaking up rehab services with a fresh, standout approach. We offer a wide range of services, stick to top-notch systems, and work in strategic locations to get the best results for our patients and support our clients' goals. We're all about clear communication, using our deep experience to deliver therapy that's both effective and affordable. Our reputation is built on great patient care, happy clients and staff, and solid management. We are proud to exceed expectations for patients, families, healthcare providers, and businesses.
We prioritize both exceptional patient care and the well-being of our employees. We are committed to delivering compassionate, results-driven therapy while offering the flexibility and comprehensive benefits needed to thrive in today's healthcare environment. Our team is large enough to offer competitive pay and benefits but small enough to ensure personalized attention and support for your career aspirations.
Whether you're looking for a role that accommodates family commitments, travel plans, home projects, or future savings, we provide tailored solutions to fit your lifestyle. Join us and experience a workplace that values your individual needs and career goals. Come experience a rewarding career where you're valued and supported every step of the way.
We offer a creative, engaging, and flexible work environment, alongside a comprehensive benefits package designed to support your success and well-being:
MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS division as a full-time Senior Director of Operations.
Education:
• Required: Graduate of an accredited college or university with a bachelor's in nursing
Experience:
• Required: At least 5 years of clinical experience, with 3 or more years of experience with the RAI process
Licenses/Certificates:
• Required: Current and unrestricted RN license in state(s) assigned
• Required: RAC-CT certification upon hire or within 6 months of hire.
• Required: Valid driver license and car insurance as required by state law.
• Required: Other as required by federal, state and local standards
Other Requirements:
• Proficient knowledge of PDPM and State Case Mix Reimbursement payment systems.
• Proficient in CMS Five Star Quality Measures, and Quality RFeporting Program
• Strong knowledge in current Medicare and Managed Care requirements and federal, state, and local regulations that affect skilled clinical care delivery.
• Ability to work effectively with all persons and disciplines.
• Ability to clearly articulate the complexities of RAI assessments and care planning.
• Ability to monitor MDS Coordinators and CRS's to identify areas for growth and provide mentorship for growth, while maintaining accountability for standard operating
procedures and client outcomes.
• Must possess strong customer service skills to coordinate service delivery, including attention to clients, sensitivity to issues, identification and resolution of issues to promote positive client outcomes. Initiative, innovation,
and creativity required.
• Must have dynamic presentation skills and superior communication skills.
• Must have critical thinking skills with the ability to make good decisions and exercise sound clinical and professional judgment, with proven knowledge of quality
improvement concepts and processes.
Responsibilities
The Senior Director of Operations provides leadership and oversight to assigned Directors, MDS Coordinators and Clinical Reimbursement Specialists while partnering with facility leadership to drive reimbursement optimization, quality improvement, regulatory compliance, and operational excellence. The role combines direct consulting services with leadership responsibilities to ensure clients achieve measurable and sustainable results.
The Senior Director serves as a strategic partner to clients by identifying opportunities for improvement, developing action plans, providing education, and ensuring consulting recommendations translate into sustainable results. This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
Qualifications
About Us:
At Key Rehab, we're shaking up rehab services with a fresh, standout approach. We offer a wide range of services, stick to top-notch systems, and work in strategic locations to get the best results for our patients and support our clients' goals. We're all about clear communication, using our deep experience to deliver therapy that's both effective and affordable. Our reputation is built on great patient care, happy clients and staff, and solid management. We are proud to exceed expectations for patients, families, healthcare providers, and businesses.
We prioritize both exceptional patient care and the well-being of our employees. We are committed to delivering compassionate, results-driven therapy while offering the flexibility and comprehensive benefits needed to thrive in today's healthcare environment. Our team is large enough to offer competitive pay and benefits but small enough to ensure personalized attention and support for your career aspirations.
Whether you're looking for a role that accommodates family commitments, travel plans, home projects, or future savings, we provide tailored solutions to fit your lifestyle. Join us and experience a workplace that values your individual needs and career goals. Come experience a rewarding career where you're valued and supported every step of the way.
We offer a creative, engaging, and flexible work environment, alongside a comprehensive benefits package designed to support your success and well-being:
- Competitive salaries with bonus opportunities
- Ample opportunities for promotion, transfer, and advancement
- Work that is meaningful, fulfilling, and provides high job satisfaction
- Reasonable working hours promoting work-life balance
- Continuing education (CE) opportunities for ongoing professional development
- Generous paid time off
- Comprehensive health, dental, and life insurance packages
- 401K with discretionary matching
- Mileage and licensure reimbursements
- Flexible Spending Account (FSA) and Health Savings Account (HSA) options