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Utilization Review Director Jobs in Rutherford, NJ

Samaritan Daytop Village

Utilization Manager

Queens, NY · On-site

$34.61 - $38.46/hr

Conducts timely scheduled/required utilization reviews for Residential Services sites. * Conducts ... Provides direct care services to clients as needed. * Assists with the maintenance of the agency ...

HealthCare Support

Utilization Management

Nyack, NY · On-site

Thanks to our direct client partnerships and national MSP programs, you'll have the flexibility to work where you want and go wherever your adventure takes you. Partner with HealthCare Support and ...

Evolve Treatment Centers

Clinical Director

Clark, NJ · On-site

$90 - $130/hr

He/she consults with the CEO, Physician, and Utilization Review Department as needed. The Clinical Director maintains close communication with the clinical staff, provides any information relevant to ...

PRAESUM HEALTHCARE

Clinical Director

Clark, NJ · On-site

$81K - $111K/yr

He/she consults with the CEO, Physician, and Utilization Review Department as needed. The Clinical Director maintains close communication with the clinical staff, provides any information relevant to ...

CivicMinds, Inc.

Medical director

Bronx, NY · On-site

... utilization review and case management 6. Oversee critical care services and ensure optimal patient care 7. Collaborate with other departments to enhance patient care delivery 8. MD/DO 9. Post ...

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All JobsUtilization Review JobsUtilization Review Director JobsUtilization Review Director Jobs in Rutherford, NJ

Utilization Review Director information

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How much do utilization review director jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for utilization review director in Rutherford, NJ is $43.10, according to ZipRecruiter salary data. Most workers in this role earn between $34.04 and $49.52 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 cities near Rutherford, NJ are hiring for Utilization Review Director jobs?

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

Utilization Review Director jobs near you

Utilization Manager

Samaritan Daytop Village

Queens, NY • On-site

$34.61 - $38.46/hr

Full-time

Re-posted 25 days ago

Samaritan Daytop Village rating

8.0

Company rating: 8.0 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

Job description

Overview

Utilization Manager

Healthcare staff can work anywhere....The BEST work with US!

$34.61-38.46 per hour

A nationally recognized comprehensive Health and Human Services Agency, with over 60 programs across New York City and greater New York Area.

Samaritan Daytop Village, serves over 33,000 New Yorkers annually within your neighborhoods and communities so our success depends on those we employ.

The Role

In concert with the agency's mission and goal of sustaining high quality care/service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory staff as needed with assuring compliance with external and internal utilization review/quality and appropriateness requirements.

Responsibilities

What You Will Do

  • Conducts timely scheduled/required utilization reviews for Residential Services sites.
  • Conducts timely and complete quality and appropriateness reviews on a representative sample of treatment records for residential service sites.
  • Attends monthly/other require UR Committee meetings. Prepares accurate and timely UR Committee minutes and reports. Participates in the agency's Quality Improvement / Utilization Management Committee.
  • Provides Supervisory support to CASAC Counselors and Peer Workers as needed with supervisory guidance from Management/Leadership Team.
  • Monitors and evaluates ongoing audit for chart.
  • Provides direct care services to clients as needed.
  • Assists with the maintenance of the agency's OASAS accreditation for the program, i.e., standards review and conformance auditing.
  • Performs other duties as assigned.
Qualifications

Who You Will Be

  • High School Diploma or GED required, higher education in the human services field, preferred
  • Current CASAC or the ability to complete requirements to obtain a CASAC (T) within 6 months of hire
  • At least one year of clinical or quality assurance experience in behavioral healthcare/human services organization or one year demonstrated clinical experience in substance use or mental health treatment
  • In depth knowledge on HIPAA, OASAS, and 42 CFR regulations
  • Working knowledge of quality assurance and utilization review systems
  • Proficient in Microsoft Office Suite and EHR systems.
  • Experience working with people from diverse racial, ethnic, and socioeconomic backgrounds.
  • Strong written, verbal, and interpersonal communication skills.
  • Ability to accurately document records according to program standards.
  • Ability to work independently.
  • Spanish bilingual skills are a plus.

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Employment Type: FULL_TIME

What Samaritan Daytop Village employees say

Pay

Hours and flexibility

Workplace

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