Director of Utilization Review
Responsibilities
The Director of Utilization Review provides executive leadership and operational oversight for all inpatient and outpatient utilization review, care management, and payer authorization functions. This role ensures that services provided are medically necessary, clinically appropriate, and authorized in accordance with payer, regulatory, and accreditation requirements. The Director serves as the primary liaison between managed care organizations, external reviewers, Medicaid, and facility leadership. This position drives denial prevention strategies, ensures effective communication across clinical and financial teams, and aligns utilization management practices with organizational goals, regulatory standards, and patient-centered care delivery.
Qualifications
- Education: Bachelor's Degree from an accredited college or university. Clinical field of study in social work, nursing, or similar discipline preferred.
- Experience: One to Five (1-5) years required of related experience, with expert knowledge of utilization review processes, managed care, Medicare, and Medicaid requirements. One to Five (1-5) years preferred of managerial experience to hiring, supervision, and staff evaluation.
- Licensure: Must attend in-house CPR and Handle With Care certification.
Additional Requirements
- Strong understanding of psychiatric treatment planning, levels of care, and discharge planning.
- Knowledge of Joint Commission, CMS, and state regulatory requirements.
- Ability to analyze denial trends, payer behavior, and authorization outcomes.
Benefits
Competitive Salary
Generous Paid Time-off
Wide Range of Medical & Voluntary Benefits
Discounted meals
A challenging and rewarding work environment
Growth and development opportunities within UHS and its 300+ facilities