Director of Utilization Management Jobs
Director of Utilization Management jobs are open across health systems, managed care organizations, insurance payers, and physician groups, at every level from manager to VP, with specializations in clinical denials management, care coordination, and payer contract compliance. See the openings below and apply to the ones that match your experience.
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Showing 5 of 170+ Director of Utilization Management jobs
50 West Town Street
Columbus, Ohio, 43215
United States
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine’s agenda for Ohio’s future. To ensure Ohio is “the best place to live, work, raise and family and start a business,” we must have strong schools, a great quality of life, and compassion for those who need our help.
Ohio Department of Medicaid plays a unique and necessary role in supporting the governor’s vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:
- Delivering a personalized care experience to more than three million people served.
- Improving care for children and adults with complex behavioral health needs.
- Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
- Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
- Ensuring financial transparency and operational accountability across all Medicaid programs and services.
Office: Health Innovation &Quality
Bureau: Clinical Operations
Classification: Medicaid Health Systems Specialist RN (PN: 20102136)
Job Overview:
As the Utilization Management (UM) Nurse in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:
- Reviews Clinical Coverage Policies (CCPs) of the managed care plans to ensure managed care coverage meets medical necessity, benefit coverage rules, and applicable Ohio Administrative Code standards.
- Conducts validation of pre and post services across all service categories Durable Medical Equipment (DME), inpatient/outpatient to meet required clinical criteria and documentation thresholds
- Assists with rules language by interpreting Fee for Service (FFS) rules against managed care impact and CCP requirements
- Verifies completeness, prior authorization and other submissions in alignment with UM policy requirements.
- Participates in cross-team collaboration with medical directors, reviewers, policy teams, and managed care leads to ensure UM consistency and alignment with statewide managed care requirements.
Compensation is as listed on the posting unless required by legislation or union contract.
Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
- Medical Coverage
- Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
- Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
- Childbirth, Adoption, and Foster Care leave
- Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
- Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)
- Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
- Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.
- Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.
- Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
Job Skills: Nursing, Health Administration
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
50 West Town Street
Columbus, Ohio, 43215
United States
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine’s agenda for Ohio’s future. To ensure Ohio is “the best place to live, work, raise and family and start a business,” we must have strong schools, a great quality of life, and compassion for those who need our help.
Ohio Department of Medicaid plays a unique and necessary role in supporting the governor’s vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:
- Delivering a personalized care experience to more than three million people served.
- Improving care for children and adults with complex behavioral health needs.
- Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
- Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
- Ensuring financial transparency and operational accountability across all Medicaid programs and services.
Office: Health Innovation &Quality
Bureau: Clinical Operations
Classification: Medicaid Health Systems Specialist RN (PN: 20102136)
Job Overview:
As the Utilization Management (UM) Nurse in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:
- Reviews Clinical Coverage Policies (CCPs) of the managed care plans to ensure managed care coverage meets medical necessity, benefit coverage rules, and applicable Ohio Administrative Code standards.
- Conducts validation of pre and post services across all service categories Durable Medical Equipment (DME), inpatient/outpatient to meet required clinical criteria and documentation thresholds
- Assists with rules language by interpreting Fee for Service (FFS) rules against managed care impact and CCP requirements
- Verifies completeness, prior authorization and other submissions in alignment with UM policy requirements.
- Participates in cross-team collaboration with medical directors, reviewers, policy teams, and managed care leads to ensure UM consistency and alignment with statewide managed care requirements.
Compensation is as listed on the posting unless required by legislation or union contract.
Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
- Medical Coverage
- Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
- Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
- Childbirth, Adoption, and Foster Care leave
- Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
- Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)
- Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
- Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.
- Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.
- Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
Job Skills: Nursing, Health Administration
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
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Find JobsDirector of Utilization Management Job Market
Who's Hiring
Top Industries Hiring
- Insurance
- Healthcare & Medical Services
- Education
- Manufacturing
- Technology & Software
What Employers Look For
The qualifications that appear most often in director of utilization management jobs.
- Registered nurse or licensed clinician with an active, unrestricted state license
- Five or more years of utilization management or case management experience in an acute or managed care setting
- Working knowledge of InterQual or MCG clinical decision-support criteria
- Demonstrated experience managing clinical denials, appeals, and peer-to-peer review processes
- Proficiency with care management platforms and electronic health record systems
- CPHM, ACM, or CCM certification preferred by most health system and payer employers
Tips for Your Director of Utilization Management Job Search
Quantify your denial overturn rate
Hiring managers in this role want to see outcomes, not just duties. Pull your actual denial overturn percentages, days-to-authorization metrics, and cost-avoidance figures from your last role and lead with them in your resume summary and bullet points.
Align credentials to the posting's payer mix
A role at a Medicare Advantage plan values different credentials than one at a commercial payer. Check whether the posting emphasizes InterQual, MCG, or proprietary criteria, and mirror that language explicitly in your application materials.
Apply early to roles that fit
Migrate Mate lists director of utilization management openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Target postings by accreditation environment
Some employers operate under URAC or NCQA accreditation requirements that shape the UM director's daily work. If you have experience maintaining accreditation standards, call that out explicitly rather than burying it in a general compliance bullet.
Prepare for a case-scenario interview round
Many UM director interviews include a live scenario where you walk through a denial, appeal, or escalation case. Practice narrating your clinical reasoning, the regulatory framework you applied, and how you documented the decision for audit purposes.
Negotiate scope before discussing compensation
In UM director offers, the reporting structure and staffing ratio matter as much as pay. Clarify how many nurses or coordinators you'll oversee, what committee responsibilities are included, and whether the role owns the appeals function before you finalize any offer.
Director of Utilization Management Jobs: Frequently Asked Questions
Which companies are hiring the most director of utilization managements?
The most active employers for director of utilization managements right now are CommunityCare, Optum, and UF Health, and the most openings are in California, New York, and Florida, based on current listings on Migrate Mate as of November 2026. Health systems, national managed care organizations, and regional insurance payers collectively account for the largest share of active postings.
How many director of utilization management jobs are remote?
About 77% of director of utilization management openings are fully remote or hybrid as of November 2026, reflecting sustained demand for experienced clinical leaders who can manage distributed UM teams. Fully remote arrangements are most common at national payers and telehealth-adjacent managed care organizations, where on-site rounding requirements are minimal.
How do you become a director of utilization management?
Start with an active clinical license, typically as a registered nurse, and gain several years of hands-on utilization review or case management experience in a hospital or health plan setting. Build familiarity with payer criteria tools, federal and state UM regulations, and appeals workflows. Move into a supervisory UM role, pursue a certification such as ACM or CCM, and demonstrate measurable outcomes in denial management before targeting director-level postings.
Can I get a director of utilization management job with limited leadership experience?
It's possible if your clinical and UM technical experience is strong. Employers occasionally promote senior UM nurses or case managers who have informally led teams, trained staff, or managed accreditation projects, even without a formal management title. Framing any project leadership, committee participation, or mentor role in your resume helps close the gap. Smaller health systems and community hospitals tend to be more flexible than large payers or academic medical centers.
What does the director of utilization management interview process look like?
Most processes include an initial screen with HR or a talent partner, a panel interview with clinical operations and compliance leadership, and at least one working session where you walk through a denial scenario or present a sample UM program improvement. Some employers also request a writing sample such as a policy draft or committee report. The full process typically runs across several weeks and may include a final conversation with a Chief Medical Officer or VP of Care Management.
Where can I find and apply to director of utilization management jobs?
You can find and apply to director of utilization management jobs on Migrate Mate, which lists current openings from health systems, payers, and managed care organizations across the United States. Search for roles that fit your clinical background and leadership experience, then apply directly to each listing that matches.
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