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Utilization Review Management Medstar Jobs (NOW HIRING)

Discovery Institute NJ

Utilization Review

Marlboro, NJ · On-site

Monitor payer portals for authorization updates. * Assist with Medicaid and managed care authorization processes. * Participate in utilization review meetings and case conferences. * Generate reports ...

Discovery Institute

Utilization Review

Marlboro, NJ · On-site

Monitor payer portals for authorization updates. * Assist with Medicaid and managed care authorization processes. * Participate in utilization review meetings and case conferences. * Generate reports ...

Slate Healthcare

RN - Utilization Review

Fort Myers, FL · On-site

Utilization Review Manager In this role, you will manage utilization review processes, ensuring quality patient care while optimizing resource use. Your responsibilities include assessing patient ...

Discovery Institute NJ

Utilization Review

Marlboro, NJ · On-site

Monitor payer portals for authorization updates. * Assist with Medicaid and managed care authorization processes. * Participate in utilization review meetings and case conferences. * Generate reports ...

Kaiser Permanente

Utilization Review Nurse III

Renton, WA · On-site

$65.86/hr

PRIOR UTILIZATION REVIEW/UTILIZATION MANAGEMENT RN WORK EXPERIENCE HIGHLY PREFERRED! ** ** MUST LIVE IN WASHINGTON OR IDAHO, COMMUTABLE DISTANCE TO KAISER PERMANENTE WASHINGTON MEDICAL CENTER ** Job ...

Discovery Institute NJ

Utilization Review

Marlboro, NJ · On-site

Monitor payer portals for authorization updates. * Assist with Medicaid and managed care authorization processes. * Participate in utilization review meetings and case conferences. * Generate reports ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... This includes the implementation of case management scenarios, consulting with all services to ...

Memorial Physician Practices

$100 - $125/hr

From your first day to your next career milestone-your experience matters How you'll contribute The responsibility of the UR Manager is to ensure the utilization review activities are completed ...

New

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... This includes the implementation of case management scenarios, consulting with all services to ...

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Utilization Review Management Medstar information

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How much do utilization review management medstar jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for utilization review management medstar 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 are popular job titles related to Utilization Review Management Medstar jobs?

For Utilization Review Management Medstar jobs, the most frequently searched job titles are:

Infographic showing various Utilization Review Management Medstar job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Director of Utilization Review

Cincinnati, OH

New Vista Behavioral Health
Offices of Mental Health Practitioners • 51 - 200 employees
Learn more about New Vista Behavioral Healthexternal

$78K - $100K/yr

Full-time

Posted 5 days ago

Job description

Corporate Director of Utilization Review

New Vista Behavioral Health

Pay Range: $78k - $100k per year
Schedule: Full Time
Location: Blue Ash, OH

New Vista Behavioral Health is seeking an experienced Corporate Director of Utilization Review to provide strategic leadership and oversight of utilization review and utilization management across our behavioral health organization.

This is a high-impact corporate leadership role responsible for ensuring clinically appropriate, timely, and financially responsible utilization of behavioral health services. The Director will partner with clinical, medical, operations, revenue cycle, quality, compliance, admissions, discharge planning, and payer relations teams to optimize authorizations, reduce avoidable denials, support appropriate length of stay, and promote timely transitions of care.

Key Responsibilities
  • Lead and oversee the organization’s enterprise-wide Utilization Review program and establish consistent best practices across facilities and programs.
  • Develop and implement standardized UR policies, workflows, performance expectations, and quality metrics.
  • Oversee initial, concurrent, continued-stay, retrospective, and discharge-related utilization reviews.
  • Ensure timely and accurate submission of clinical information and authorization requests to managed care organizations and other payers.
  • Monitor authorization outcomes, denials, length of stay, continued-stay days, and other utilization trends.
  • Develop strategies to prevent avoidable denials and improve payer authorization and appeal outcomes.
  • Oversee peer-to-peer reviews, clinical escalations, and medical necessity appeals.
  • Partner with clinical leadership to ensure documentation supports medical necessity, level of care, treatment needs, and continued stay.
  • Establish and monitor corporate UR dashboards and key performance indicators.
  • Identify trends and opportunities for operational, clinical, and financial improvement.
  • Provide coaching, mentoring, and leadership to facility-level UR teams and managers.
  • Collaborate with Revenue Cycle, Payer Relations, Quality, Compliance, Medical Staff, and Operations to resolve utilization and reimbursement challenges.
  • Maintain compliance with applicable regulatory, accreditation, payer, and organizational requirements.
  • Serve as the organization’s subject-matter expert on behavioral health utilization management and medical necessity.
Qualifications
  • Bachelor’s degree in Nursing, Healthcare Administration, Social Work, Psychology, or a related healthcare field required.
  • Master’s degree preferred.
  • Active clinical license or applicable professional credential preferred.
  • 7+ years of progressive healthcare experience, including significant behavioral health utilization review/management experience.
  • 3–5+ years of leadership experience, preferably in a multi-site or corporate healthcare environment.
  • Strong knowledge of behavioral health levels of care, medical necessity, payer authorization, concurrent review, denials, peer-to-peer reviews, and appeals.
  • Demonstrated success improving authorization outcomes and reducing avoidable denials.
  • Strong analytical, organizational, communication, and leadership skills.
  • Experience with behavioral health EHRs, payer portals, and utilization management systems preferred.
  • Knowledge of InterQual, MCG, ASAM, LOCUS, or other applicable clinical criteria is a plus.

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