Conducts utilization reviews of behavioral health cases to determine medical necessity ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Conducts utilization reviews of behavioral health cases to determine medical necessity ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Utilization Review Clinician (RN) - Behavioral Health
Columbus, OH · On-site
$23.76 - $51.49/hr
... Utilization Reviews. SCHEDULE: Monday thru Friday 8:00AM to 5:00PM EST (Rotating weekends and ... Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient ...
Utilization Review Clinician (RN) - Behavioral Health
Columbus, OH · On-site
$23.76 - $51.49/hr
... Utilization Reviews. SCHEDULE: Monday thru Friday 8:00AM to 5:00PM EST (Rotating weekends and ... Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient ...
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... Collaborates with program directors, treatment providers, and billing staff to resolve ...
Quick apply
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... Collaborates with program directors, treatment providers, and billing staff to resolve ...
Care Review Processor I
Columbus, OH · On-site
... utilization review for other healthcare services. * Checks eligibility and verifies benefits ... Director. * Provide excellent customer service for internal and external customers. * Meet ...
Care Review Processor I
Columbus, OH · On-site
... utilization review for other healthcare services. * Checks eligibility and verifies benefits ... Director. * Provide excellent customer service for internal and external customers. * Meet ...
Care Review Processor I
Columbus, OH · On-site
... or utilization review for other healthcare services. Checks eligibility and verifies benefits ... Medical Director. Provide excellent customer service for internal and external customers. Meet ...
Care Review Processor I
Columbus, OH · On-site
... or utilization review for other healthcare services. Checks eligibility and verifies benefits ... Medical Director. Provide excellent customer service for internal and external customers. Meet ...
Medical Review Nurse (RN)
Columbus, OH · On-site
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... criteria with medical directors on denial decisions. • Supplies criteria supporting all ...
Medical Review Nurse (RN)
Columbus, OH · On-site
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... criteria with medical directors on denial decisions. • Supplies criteria supporting all ...
Resolves escalated complaints regarding utilization management and long-term services and supports ... criteria with medical directors on denial decisions. Supplies criteria supporting all ...
Resolves escalated complaints regarding utilization management and long-term services and supports ... criteria with medical directors on denial decisions. Supplies criteria supporting all ...
Medical Review Nurse (RN)
Columbus, OH · On-site
$29.05 - $56.64/hr
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... criteria with medical directors on denial decisions. • Supplies criteria supporting all ...
Medical Review Nurse (RN)
Columbus, OH · On-site
$29.05 - $56.64/hr
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... criteria with medical directors on denial decisions. • Supplies criteria supporting all ...
Medical Review Nurse (RN)
Columbus, OH · Remote
$29.05 - $56.64/hr
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... criteria with medical directors on denial decisions. • Supplies criteria supporting all ...
Medical Review Nurse (RN)
Columbus, OH · Remote
$29.05 - $56.64/hr
... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... criteria with medical directors on denial decisions. • Supplies criteria supporting all ...
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... May assist the Senior Medical Director in research activities/questions related to the Utilization ...
Family Practice Physician Outpatient Only Practitioner - Physicians Only Apply - Perm
Columbus, OH · On-site
$215K - $344K/yr
Medical Director / Columbus, OH Allied Specialty - State Ohio Physican Speciality Pediatrics ... Performs medical review activities pertaining to utilization review, quality assurance, and medical ...
Family Practice Physician Outpatient Only Practitioner - Physicians Only Apply - Perm
Columbus, OH · On-site
$215K - $344K/yr
Medical Director / Columbus, OH Allied Specialty - State Ohio Physican Speciality Pediatrics ... Performs medical review activities pertaining to utilization review, quality assurance, and medical ...
Care Review Processor
Columbus, OH · On-site
... utilization review for other healthcare services * Checks eligibility and verifies benefits ... IT Life Sciences Allied Healthcare CRO DIRECT # - (650)-399-0891 Gold Seal JCAHO Certified ™ for ...
Care Review Processor
Columbus, OH · On-site
... utilization review for other healthcare services * Checks eligibility and verifies benefits ... IT Life Sciences Allied Healthcare CRO DIRECT # - (650)-399-0891 Gold Seal JCAHO Certified ™ for ...
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Required Experience: * 5 years post graduate experience in direct patient care. * Required Software ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Utilization review, and/or discharge planning experience desirable. Physical Requirements ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Utilization review, and/or discharge planning experience desirable. Physical Requirements ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
The Physical Medicine and Rehabilitation Medical Director may also write and revise medical ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
The Physical Medicine and Rehabilitation Medical Director may also write and revise medical ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
The Physical Medicine and Rehabilitation Medical Director may also write and revise medical ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
The Physical Medicine and Rehabilitation Medical Director may also write and revise medical ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Utilization review, and/or discharge planning experience desirable. Physical Requirements ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Utilization review, and/or discharge planning experience desirable. Physical Requirements ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Utilization review, and/or discharge planning experience desirable. Physical Requirements ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Utilization review, and/or discharge planning experience desirable. Physical Requirements ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Utilization review, and/or discharge planning experience desirable. Physical Requirements ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet
Utilization review, and/or discharge planning experience desirable. Physical Requirements ... direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet
Utilization Review Director information
See salary details
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
How much do utilization review director jobs pay per hour?
As of Aug 14, 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 cities are hiring for Utilization Review Director jobs?
Cities with the most Utilization Review Director job openings:
What states have the most Utilization Review Director jobs?
States with the most job openings for Utilization Review Director jobs include:
What are the most commonly searched types of Utilization Review jobs?
The most popular types of Utilization Review jobs are:
Full-time
Posted 23 days ago
Nationwide Children's Hospital rating
6.9
Based on 131 frontline employees who took The Breakroom Quiz
552nd of 1,059 rated hospitals
Job description
Overview:
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Job Description:
Essential Functions:
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
Experience:
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Job Description:
Essential Functions:
- Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines.
- Communicates with healthcare teams and third-party payors to ensure the delivery of quality care and optimum payment.
- Assists with retrospective reviews and denial management to maintain appropriate and cost-effective patient care.
- Documents all case reviews and maintains accurate records of all clinical activities and coverage information.
- Provides education and support regarding utilization review and management activities and processes.
- Analyzes clinical data to identify trends and patterns that may impact patient care. Participates in quality improvement initiatives to enhance the overall delivery of behavioral health services.
- Facilitates reimbursement by communicating with payers, other staff, patients, and families concerning status of funding and required actions.
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
- Excellent written and verbal communication and interpersonal skills.
- Excellent customer service and organizational skills.
- Working knowledge of CMS and other review agency standards.
- Proficient with software applications including CM, payer web applications, MITS, and others.
Experience:
- Three years of behavioral health experience, required.
- One year of experience in pediatric care or services, required.
- Utilization review or utilization management experience, preferred.
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
What Nationwide Children's Hospital employees say
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Get the full story on Breakroom
About Nationwide Children's Hospital
Sourced by ZipRecruiter
Nationwide Children's Hospital, established in 1894, is a leading pediatric healthcare system based in Columbus, Ohio, United States. They serve as a primary pediatric network, providing wellness, preventive, diagnostic, treatment, and rehabilitative care for infants, children, adolescents, and adults with congenital disease. Being the third-largest pediatric hospital in the nation, Nationwide Children's Hospital prides itself on its relentless commitment to children and their families, driven by their core values of respect, integrity, determination, empathy, and solidarity. The institution's comprehensive mission is to enhance the health of children by providing high-quality, family-centered care, conducting groundbreaking research, advocating for pediatric health, and training top healthcare professionals.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Columbus, OH, US
Year founded
1892