| Medical Utilization Review Director Job Description |
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| The following is a full job description for Medical Utilization Review Director. Here are the requirements and responsibilities for Medical Utilization Review Director along with statistics. If after reading this page you determine that Medical Utilization Review Director is not the position you are looking for, you may want to try one of these similar titles: Medical Utilization Review Manager, Medical Utilization Review Supervisor, Medical Utilization Review Senior Manager, Medical Utilization Review Specialist I, Medical Utilization Review Specialist II, Medical Utilization Review Specialist III, Dental Utilization Review Analyst, Utilization Review Technician, Utilization Review Coordinator |
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| Requirements and Responsibilities For Medical Utilization Review Director |
| Directs the team responsible for evaluating proposed and/or delivered healthcare services to determine if the services meet established health plan coverage guidelines. Receives, reviews, and acts on pre-authorization requests from service providers for medical procedures, treatments, admissions, and medications. Reviews patient and clinical information to ensure compliance with established utilization review guidelines. Refers more complex requests and those that need clinical review to a medical reviewer. Requires a bachelor's degree. Typically reports to senior management. Manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. |
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| Also referred to as: Healthcare Utilization Review Director |
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| Similar Jobs: Medical Utilization Review Manager, Medical Utilization Review Supervisor, Medical Utilization Review Senior Manager, Medical Utilization Review Specialist I, Medical Utilization Review Specialist II, Medical Utilization Review Specialist III, Dental Utilization Review Analyst, Utilization Review Technician, Utilization Review Coordinator |
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| Level of Education: Medical Utilization Review Director Salaries with No Diploma, Medical Utilization Review Director Salaries with a High School Diploma or Technical Certificate, Medical Utilization Review Director Salaries with an Associate's Degree, Medical Utilization Review Director Salaries with a Bachelor's Degree, Medical Utilization Review Director Salaries with a Master's Degree or MBA, Medical Utilization Review Director Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
