Director of Utilization Review

Desert Parkway; Las Vegas (NV); On-site; USD 120,000 - 170,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401K Retirement Plan

Healthcare spending account

Dependent care spending account

PTO Plan with holiday premium pay

Discounted cafeteria meal plan

Life insurance

Short- and long-term disability

Pet Insurance

Identity Theft Insurance

Job summary

Desert Parkway seeks a Director of Utilization Review to lead the UR department, overseeing a team that tracks authorized care, monitors lengths of stay, and ensures medical necessity support. You will act as the main bridge between clinical staff, medical providers, and external insurance payers.

Key responsibilities include directing concurrent, continued stay, and retrospective reviews, preventing denials, and managing appeals with physicians and payers.

Qualifications

• Active clinical license requirements include RN, LCSW, LMFT or LPC.
• Minimum five years in healthcare utilization management/review.
• Minimum three years of supervisory or management experience.
• Strong understanding of medical necessity criteria and payer guidelines.

Responsibilities

• Lead the daily work of the utilization review team and monitor the use of hospital services.
• Direct concurrent, continued stay, and retrospective medical record reviews.
• Prevent avoidable claim denials and handle clinical appeals and peer-to-peer reviews.
• Partner with physicians, therapists, nursing staff, and revenue cycle to prevent delays in care.
• Keep the department aligned with state, federal, accreditation, and payer rules.
• Monitor admissions and extended hospital stays for appropriateness.
• Prepare and submit appeals to third party payors.
• Manage hiring, training, mentoring, and performance management for UR staff.

Skills

Utilization Review leadership

Supervisory experience

Medical necessity criteria

Payer guidelines knowledge

Interdepartmental collaboration

Education

RN

LCSW

LMFT

LPC

Job description

The Director of Utilization Review manages the day-to-day operations of our Utilization Review (UR) department. You will lead a team that tracks authorized care, monitors lengths of stay, and ensures that clinical documentation supports medical necessity. You act as the main bridge between our clinical staff, medical providers, and external insurance payers.

Key Responsibilities

• Lead the daily work of the utilization review team and monitor the use of hospital services.
• Direct concurrent, continued stay, and retrospective medical record reviews.
• Work to prevent avoidable claim denials and handle clinical appeals and peer-to-peer reviews.
• Partner with physicians, therapists, nursing staff, and the revenue cycle team to prevent delays in care and support proper reimbursement.
• Keep the department aligned with state, federal, accreditation, and insurance payer rules.
• Monitor the appropriateness of hospital admissions and extended hospital stays.
• Prepare and submit appeals to third party payors.
• Manage hiring, training, mentoring, and performance management for UR staff.

Requirements

• Active clinical license (RN, LCSW, LMFT, LPC) required.
• Minimum five (5) years of experience in healthcare utilization management/review, preferably in a behavioral health setting.
• Minimum three (3) years of supervisory or management experience required.
• Strong understanding of medical necessity criteria and local insurance payer guidelines.

Benefits

A full benefits package is available the first of the month following 30 days of employment!

Desert Parkway offers competitive benefits to include:

• Medical insurance
• Dental insurance
• Vision insurance
• 401K Retirement Plan
• Healthcare spending account
• Dependent care spending account
• PTO Plan with holiday premium pay
• Discounted cafeteria meal plan
• Life insurance (including plans for spouse and children)
• Short- and long-term disability (with additional buy-in opportunities)
• Pet Insurance
• Identity Theft Insurance