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Utilization Review Director Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

Director of Utilization Review * Schedule: Full-Time, Weekdays (Weekend availability as needed). * Location: Remote Key Responsibilities: * Manage a caseload of 50-75 patients and authorize 15-25 ...

HHC

UTILIZATION REVIEW SPECIALIST

Indianapolis, IN

Ability to provide direct support to providers regarding utilization, authorization, and referral ... Hospital Review for four consecutive years and Forbes list of best places to work for women, and ...

tmn

Utilization Review Specialist

Akron, OH · On-site

$40K/mo

SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... May direct and supervise clerical and administrative staff * Provides feedback on performance ...

ERC Pathlight

Utilization Review Manager

Aspen, CO · Hybrid

This role coordinates with Clinical Managers and Directors, Physicians, Business Office, and Managed Care Organizations to assure the smooth operation of Utilization Review functions and the ...

tmn

Utilization Review Specialist

Akron, OH · On-site

$40K/mo

SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... May direct and supervise clerical and administrative staff * Provides feedback on performance ...

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Utilization Review Director information

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How much do utilization review director jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for utilization review director in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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.

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 cities are hiring for Utilization Review Director jobs? Cities with the most Utilization Review Director job openings:
What are the most commonly searched types of Utilization Review jobs? The most popular types of Utilization Review jobs are:
What states have the most Utilization Review Director jobs? States with the most job openings for Utilization Review Director jobs include:
Utilization Review Director jobs near you

Utilization Review Nurse

Fusion HCR

Las Vegas, NV

Full-time

Posted yesterday

Job description

Fusion HCR is hiring!  Direct Hire – Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. 
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations
Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines
Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines
Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment
Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!