Find Jobs
Find Jobs Near You – Available Work in Your Location
Director of Utilization Review
Career Insights for Clinical Auditor / Utilization Reviewer
See where this job fits in the broader career landscape. Knowing your career path helps you see what's possible from here.
Scorecard
Based on Pennsylvania data
Review key factors to help you decide if this role fits your goals. How is this calculated?
What they do
A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
$95,917 / year median in Pennsylvania
-9% projected decline
Job Description
The Director of Utilization Review (UR) is to manage effectively and efficiently all aspects of the MDS/ Case management / Restorative/ Care planning/ 5 Star and Quality Measures while capturing clinical reimbursement. This should be done while following the RAI manual, DOH guidelines, CMS guidelines, Federal and State Guidelines and Corporate Compliance. 1) Graduate of an accredited School of Nursing with current Pennsylvania nursing license 2) Maintain CEU credits through seminars, in-service programs, and professional journals relative to professional growth 3) Strong knowledge of the RAI, MDS, state and federal guidelines, 5 star reporting and quality measures, and restorative nursing