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Utilization Review Director Jobs in Rutherford, NJ

Medix

Director of Utilization Management

Manhattan, NY · On-site

$109.15 - $151.44/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Job Summary Our client is seeking a skilled Director of Utilization Management to oversee the ... Document all case reviews utilizing the care management system. * Participate in case rounds and ...

ICL

Clinic Director (LCSW Required) - 64542301

Brooklyn, NY · On-site

$82K - $111K/yr

JOB SUMMARY The Clinic Director provides senior leadership and operational oversight for the MHOTRS ... Leads the Utilization Review Committee, ensuring adherence to clinical, billing, and regulatory ...

Acacia Network

Program Director

Bronx, NY · On-site

$85K/yr

  • Medical

  • Dental

  • Vision

  • PTO

The Program Director provides clinical supervision and oversight of all programs' services and ... Perform utilization reviews, monitoring case records, ensuring compliance with all contract ...

Cobble Hill

MDS Director (Registered Nurse)

New York, NY

$140K - $160K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Participate in QAPI, Utilization Review, Therapy, and Medical Board meetings Requirements * Active RN License - New York * 3+ years experience as MDS Coordinator or MDS Director * Strong knowledge of ...

Cobble Hill

MDS Director (Registered Nurse)

Brooklyn, NY · On-site

$39.25 - $47.50/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Participate in QAPI, Utilization Review, Therapy, and Medical Board meetings Requirements * Active RN License - New York * 3+ years experience as MDS Coordinator or MDS Director * Strong knowledge of ...

Molina Healthcare

Medical Director (New York)

New York, NY · On-site

$186K - $363K/yr

... NCQA) and utilization review accreditation commission (URAC) certifications. • Provides ... directed by the chief medical officer. • Evaluates authorization requests in timely support of ...

Hurc LLC

Physician Advisor

Short Hills, NJ · On-site

Prior experience as a Physician Advisor, Medical Director, or in Utilization Review * Familiarity with CMS guidelines, InterQual, MCG, and denial management processes * Experience working with case ...

Hurc LLC

Physician Advisor

Short Hills, NJ · On-site

Prior experience as a Physician Advisor, Medical Director, or in Utilization Review * Familiarity with CMS guidelines, InterQual, MCG, and denial management processes * Experience working with case ...

HURC

Physician Advisor

Short Hills, NJ · Remote

Prior experience as a Physician Advisor, Medical Director, or in Utilization Review * Familiarity with CMS guidelines, InterQual, MCG, and denial management processes * Experience working with case ...

Hurc LLC

Physician Advisor

Short Hills, NJ · Remote

Prior experience as a Physician Advisor, Medical Director, or in Utilization Review * Familiarity with CMS guidelines, InterQual, MCG, and denial management processes * Experience working with case ...

Veterans Sourcing Group

Medical Director

New York, NY · Remote

$225K - $300K/yr

  • Medical

Medical Director (Non Behavioral Health (Physical Health)) Start/End Dates: 6/1/2026 - 12/31/2026 ... In addition to utilization review, the incumbent participates as the physician member of the ...

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

Utilization Review Director information

See Rutherford, NJ salary details

$21

$43

$70

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

Director of Utilization Management

Medix

Manhattan, NY • On-site

$109.15 - $151.44/hr

Full-time

Medical, Dental, Vision, Retirement

Posted 12 days ago

Job description

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a skilled Director of Utilization Management to oversee the delivery of utilization management services, including case reviews, peer reviews, and appeals. The successful candidate will ensure compliance with regulatory requirements, participate in audits and reviews, and contribute to the development and attainment of annual goals.
Key Responsibilities
  • Responsible for oversight of utilization management services and resources through case reviews, peer reviews, and appeals.
  • Document all case reviews utilizing the care management system.
  • Participate in case rounds and ICT meetings to develop UM/CM plans for patient continuity of care.
  • Analyze utilization patterns, trends, and implement strategies to align with expected benchmarks.
  • Ensure compliance with regulatory and contractual requirements for Medical Management functions.
  • Participate in State and Federal Regulatory audits, investigations, surveys, and reviews.
  • Maintain current knowledge of Federal and State regulatory requirements.
  • Develop and propose annual goals, providing regular progress reports.

Qualifications
  • Medical Doctorate is required.
  • Current and unrestricted Physician license to practice in New York.
  • Preferred: Board Certification in internal medicine, emergency medicine, or family medicine.
  • Preferred: Master's Degree in public health.

Experience
  • 3-5 years of health plan experience in medical management, particularly with Medicare and Medicaid Programs.
  • Experience with both inpatient and outpatient utilization management, including medical and pharmacy utilization.
  • Experience with appeal reviews.
  • NY Market Experience.

Skills
  • Strong ability to analyze utilization patterns and implement strategies for benchmark alignment.
  • Effective communication skills for participation in audits, reviews, and cross-departmental collaboration.

Additional Requirements
  • M-F 9-5 Work Schedule.

Benefits
  • Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
  • Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
  • 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
  • Short Term Disability Insurance.
  • Term Life Insurance Plan.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
Any required state or Joint Commission training is compensated at the state or local minimum wage rate.
* As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
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About Medix Staffing Solutions

Sourced by ZipRecruiter

Since 2001, we’ve been dedicated to helping you achieve your goals. Medix was created to become a leading provider of workforce solutions for clients and candidates across the healthcare and life sciences industries. Today, we are that leader. Headquartered in Chicago, we have 23 offices across the United States, and staff talent around the world. Medix is committed to fulfilling our core purpose as an organization: to positively impact the lives of our talent, clients, and teammates through employment, philanthropy, and opportunity. The combination of purpose and values has nurtured our thriving culture that encourages our internal team to excel at work and in everyday life.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

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