Director of Utilization Review

New Vista Behavioral Health; Cincinnati (OH); On-site; USD 78,000 - 100,000; Full time

Job summary

New Vista Behavioral Health in Blue Ash, OH seeks an experienced Corporate Director of Utilization Review to lead UR programs across the organization and ensure clinically appropriate, timely, and financially responsible care. You will align clinical, operations, revenue cycle, and payer relations to optimize authorizations and transitions.

The role requires 7+ years in healthcare with UR/management, leadership across multi-site settings, and expertise in payer processes, as well as knowledge of

Qualifications

• Bachelor’s degree in Nursing, Healthcare Administration, Social Work, Psychology, or related field.
• Active clinical license preferred.
• 7+ years of healthcare experience including behavioral health utilization review/management.
• 3-5+ years of leadership in multi-site or corporate environments.
• Strong knowledge of medical necessity, payer authorization, and denials.
• Experience with UR standards including InterQual, MCG, LOCUS is a plus.

Responsibilities

• Lead enterprise-wide Utilization Review program and establish best practices.
• Develop UR policies, workflows, and quality metrics.
• Oversee initial, concurrent, continued-stay, retrospective, and discharge reviews.
• Ensure timely submission of information to payers and organizations.
• Monitor outcomes, denials, length of stay, and trends.
• Collaborate with leaders to improve documentation and transitions of care.
• Oversee peer-to-peer reviews and medical necessity appeals.
• Provide coaching to facility UR teams and managers.
• Maintain compliance with regulatory and payer requirements.

Skills

Leadership

Strategic thinking

Communication

Analytical skills

Education

Bachelor's degree

Tools

EHR systems

Payer portals

Utilization management systems

InterQual/MCG criteria

Job description

Corporate Director of Utilization Review

New Vista Behavioral Health

Pay Range: $78k - $100k per year

Schedule: Full Time

Location: Blue Ash, OH

New Vista Behavioral Health is seeking an experienced Corporate Director of Utilization Review to provide strategic leadership and oversight of utilization review and utilization management across our behavioral health organization.

This is a high-impact corporate leadership role responsible for ensuring clinically appropriate, timely, and financially responsible utilization of behavioral health services. The Director will partner with clinical, medical, operations, revenue cycle, quality, compliance, admissions, discharge planning, and payer relations teams to optimize authorizations, reduce avoidable denials, support appropriate length of stay, and promote timely transitions of care.

Key Responsibilities

• Lead and oversee the organization’s enterprise-wide Utilization Review program and establish consistent best practices across facilities and programs.
• Develop and implement standardized UR policies, workflows, performance expectations, and quality metrics.
• Oversee initial, concurrent, continued-stay, retrospective, and discharge-related utilization reviews.
• Ensure timely and accurate submission of clinical information and authorization requests to managed care organizations and other payers.
• Monitor authorization outcomes, denials, length of stay, continued-stay days, and other utilization trends.
• Develop strategies to prevent avoidable denials and improve payer authorization and appeal outcomes.
• Oversee peer-to-peer reviews, clinical escalations, and medical necessity appeals.
• Partner with clinical leadership to ensure documentation supports medical necessity, level of care, treatment needs, and continued stay.
• Establish and monitor corporate UR dashboards and key performance indicators.
• Identify trends and opportunities for operational, clinical, and financial improvement.
• Provide coaching, mentoring, and leadership to facility-level UR teams and managers.
• Collaborate with Revenue Cycle, Payer Relations, Quality, Compliance, Medical Staff, and Operations to resolve utilization and reimbursement challenges.
• Maintain compliance with applicable regulatory, accreditation, payer, and organizational requirements.
• Serve as the organization’s subject-matter expert on behavioral health utilization management and medical necessity.

Qualifications

• Bachelor’s degree in Nursing, Healthcare Administration, Social Work, Psychology, or a related healthcare field required.
• Active clinical license or applicable professional credential preferred.
• 7+ years of progressive healthcare experience , including significant behavioral health utilization review/management experience.
• 3-5+ years of leadership experience , preferably in a multi-site or corporate healthcare environment.
• Strong knowledge of behavioral health levels of care, medical necessity, payer authorization, concurrent review, denials, peer-to-peer reviews, and appeals.
• Demonstrated success improving authorization outcomes and reducing avoidable denials.
• Strong analytical, organizational, communication, and leadership skills.
• Experience with behavioral health EHRs, payer portals, and utilization management systems preferred.
• Knowledge of InterQual, MCG, ASAM, LOCUS, or other applicable clinical criteria is a plus.