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 the organization’s UR program and ensure clinically appropriate, timely, and financially responsible utilization of behavioral health services.

The role partners with clinical, operations, revenue cycle, quality, compliance, and payer relations teams to optimize authorizations, reduce denials, and support appropriate length of stay and transitions of care.

Qualifications

• Bachelor’s degree in a healthcare field is required.
• Active clinical license or credentials preferred.
• 7+ years in healthcare with UR/UM experience, behavioral health favored.
• 3-5+ years of leadership, preferably multi-site.
• Strong knowledge of payer authorization, denials, and medical necessity.
• Proven success in improving authorization outcomes.
• Analytical, organizational, and communication strengths.
• Experience with EHRs, payer portals, and UR systems.
• Knowledge of InterQual, MCG, ASAM LOCUS is a plus.

Responsibilities

• Lead enterprise-wide Utilization Review program and best practices.
• Develop UR policies, workflows, and quality metrics.
• Oversee initial, concurrent, continued-stay, retrospective reviews.
• Ensure timely submission of information to payers.
• Monitor denials, length of stay, and utilization trends.
• Develop strategies to prevent denials and improve outcomes.
• Oversee peer-to-peer reviews and medical necessity appeals.
• Partner with clinical leadership to document medical necessity.
• Establish UR dashboards and KPIs.
• Collaborate to resolve utilization and reimbursement challenges.
• Maintain regulatory and accreditation compliance.
• Serve as UR subject-matter expert for behavioral health.

Skills

Leadership

Healthcare analytics

Communication

Regulatory knowledge

Project management

Education

Bachelor’s degree in Nursing, Healthcare Administration, Social Work or related

Tools

Healthcare EHRs

Payer portals

UR systems

InterQual/MCG/ASAM LOCUS

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.