Director of Utilization Management - Behavioral Health

The Hughes Center; Danville (VA); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Work-life balance

Medical/Dental/Vision

401(k) with company match

Life Insurance

Flexible Spending or Health Savings

Paid Time Off

Career development opportunities

Challenging environment

Free meals

Stock purchase discount

Employee Assistance Program

Job summary

The Hughes Center is seeking a Director of Utilization Management to guide admissions screening and chart checks, ensuring criteria for admission, continued stay, and discharge are met. You will liaise with clinical, business, and third-party reviewers to secure appropriate hospital-level care.

This role requires 3–5 years in utilization review, Virginia licensure, and strong collaboration skills to balance resident needs with resources across a multidisciplinary team.

Qualifications

• Bachelor's degree in human services required or equivalent.
• Three to five years of utilization review and case management experience.
• RN, LCSW, LPC, LMFT, or LCP licensure in Virginia required.
• Must gather and analyze data and communicate effectively with families, payors, therapists and physicians.

Responsibilities

• Coordinate development, implementation and monitoring of UM program per standards.
• Review clinical data with third party reviewers to substantiate need for continued hospital level of care.
• Communicate third party reviewer decisions to clinical and administrative staff.
• Facilitate physician reviews with medical staff and third party reviewers.
• Attend daily multidisciplinary treatment team meetings.
• Coordinate retrospective appeals to third party payers.

Skills

Utilization review

Data analysis

Communication

Interdisciplinary collaboration

Decision making

Education

Bachelor's degree in human services

Master's degree preferred

Virginia licensure: RN/LCSW/LPC/LMFT/LCP

Job description

The Hughes Center is seeking a Director of Utilization Management to guide admissions screening and chart checks, ensuring criteria for admission, continued stay, and discharge are met. You will liaise with clinical, business, and third-party reviewers to secure appropriate hospital-level care.

This role requires 3–5 years in utilization review, Virginia licensure, and strong collaboration skills to balance resident needs with resources across a multidisciplinary team.