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How much do utilization review director jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for utilization review director in Edison, NJ is $43.77, according to ZipRecruiter salary data. Most workers in this role earn between $34.62 and $50.29 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 Edison, NJ?

The most popular types of Utilization Review jobs in Edison, NJ are:

What cities near Edison, NJ are hiring for Utilization Review Director jobs?

Cities near Edison, NJ with the most Utilization Review Director job openings:

Utilization Review Director jobs near you

Project Manager, Utilization Review

Med-Metrix

Parsippany, NJ • On-site

$100K - $125K/yr

Full-time

Posted 6 days ago

Med-Metrix rating

6.9

Company rating: 6.9 out of 10

Based on 21 frontline employees who took The Breakroom Quiz

283rd of 492 rated business services

Job description

Job Purpose
The Project Manager, Utilization Review provides operational and analytical support to Physician Advisory end-to-end clients. The Project Manager, Utilization Review will oversee implementation coordination, stakeholder management, utilization data analysis
Duties & Responsibilities
  • Prepare and participate in client review meetings (decks, data summaries, presentations)
  • Track deliverables, timelines, and client escalations
  • Support client onboarding processes and operational handoffs
  • Analyze utilization data, case trends, and client performance metrics
  • Investigate clinical and operational issues for end-to-end clients
  • Prepare data-driven summaries and recommendations for leadership review
  • Participate in evaluation of hospital UR processes and application of screening tools (MCG, IQ)
  • Support reporting infrastructure and PowerBI data validation
  • Lead ad-hoc projects for end-to-end clients as directed
  • Provide support on time-sensitive deliverables and client requests
  • Manage project timelines, resources, and stakeholder coordination
  • Serve as operational point of contact for end-to-end clients
  • Support escalation resolution and issue tracking
  • Contribute to operational efficiency improvements
  • Other duties as assigned
  • Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Understand and comply with Information Security and HIPAA policies and procedures at all times
  • Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications
  • Active RN license required
  • Utilization Review experience (required)
  • 4+ years Healthcare compliance and utilization review experience required
  • 3+ Project management experience required; PM certification a plus
  • Proficiency with data analysis tools and MCG and IQ application expertise required
  • End-to-end client or managed care operations experience
  • PowerBI or data visualization experience preferred
  • Proficiency in Microsoft Office Suite
  • Strong interpersonal skills, ability to communicate well at all levels of the organization
  • Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
  • High level of integrity and dependability with a strong sense of urgency and results oriented
  • Excellent written and verbal communication skills required

Working Conditions
  • Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes
  • Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear
  • Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress
  • Work Environment: The noise level in the work environment is usually minimal

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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