ZipRecruiter

Log In

1

Utilization Review Director Jobs (NOW HIRING)

KPC Global MSO

Utilization Review Tech

Santa Ana, CA · On-site

Reviews treatment plans and status of approvals from insurers. Collects and compiles data as ... Performs administrative duties for the Utilization Management Department, and directed in several ...

Umpqua Health

Utilization Review Clinician

Apply clinical judgment and evidence-based criteria to make utilization decisions and identify cases requiring Medical Director review. * Request and evaluate additional clinical information from ...

New

IntePros

Utilization Review Nurse

Philadelphia, PA · On-site

This role is responsible for performing utilization management reviews to determine the medical ... Present cases that do not meet medical necessity criteria to the Medical Director for final ...

New

Sevita

Utilization Review Specialist

Akron, OH · On-site

$40K/yr

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

previous page

Showing results 41-60

All JobsUtilization Review JobsUtilization Review Director Jobs

Utilization Review Director information

See salary details

$21

$42

$68

How much do utilization review director jobs pay per hour?

As of Aug 7, 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.

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 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 Specialist

New Horizons of the Treasure Coast

Fort Pierce, FL • On-site

Full-time

Posted 2 days ago

New

Job description

Description:

New Horizons is the largest mental health and addiction recovery provider on the Treasure Coast (and beyond), serving 15,000 children and adults annually through inpatient crisis services, 24-hour help line and mobile response team, and outpatient programs conveniently located across Indian River, Martin, Okeechobee and St. Lucie counties. In addition, New Horizons assists 22,000 students in area schools, and we work closely with the courts, law enforcement, jails, and hospitals to help improve the health of individuals and the quality of life in our community.


New Horizons is seeking an Utilization Review Specialist, who will be responsible for following up on patient accounts when authorization for stay is required, initiate pre-certification timely via telephone or provider portal, review patients medical record via EMR to ensure criteria for the appropriate level of care is met, and provide clinical to insurance company to obtain authorization. This position is considered a Hybrid role.



As a Utilization Review Specialist, your responsibilities will include:

  • Follow each account during the IP stay and on discharge for authorization - document status in the electronic system,
  • Escalate any potential disputes or denial of accounts to Director of Revenue or designee
  • Trends disputed claims by payor
  • Obtain & follow authorization for Case Management Services
  • Adhere to federal, state, payer, and local regulations and accreditation requirements impacting case management scope of services
  • Adhere to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and agency policies


Requirements:

REQUIRED:

  • High School diploma or equivalent required.
  • organizational skills,
  • verbal and written communication skills,
  • problem solving skills,
  • computer literacy.

Preferred:

  • Associate or Bachelor’s degree preferred.
  • Paramedic, EMT or Nursing Assistant certification preferred.
  • Acute hospital experience preferred
  • Data Analytic skills preferred.