Director of Utilization Review & Care Access

San Antonio Behavioral Healthcare Hospital; San Antonio (TX); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health Insurance

Vision Insurance

Dental Insurance

401K Retirement Plan

Healthcare Spending Account

Dependent Care Spending Account

PTO Plan

Life Insurance

Short and Long-Term Disability

Job summary

San Antonio Behavioral Healthcare Hospital is seeking a Director of Utilization Review to oversee UM/UR processes ensuring medical necessity, efficiency, and proper reimbursement. You will lead a team across clinical, finance, and payer interfaces to optimize bed days, manage denials, and ensure compliance with MHPAEA and Joint Commission standards.

The role requires a Bachelor's degree and 5 years in hospital settings with UR/claims experience, plus strong negotiation and documentation skills.

Qualifications

• Bachelor's degree in a related field; 5 years in hospital setting with 2+ in utilization review or management review.
• Experience in negotiations, quality assurance or case management is helpful.
• Strong documentation and communication skills for cross-functional coordination.

Responsibilities

• Design UM strategies to optimize resource allocation and cost-containment.
• Ensure compliance with state and federal regulations and accrediting bodies.
• Collaborate with payers to resolve disputes and manage LOS approvals.
• Provide documentation training to clinical staff reflecting treatment acuity.
• Analyze data to reduce denials and implement evidence-based practices.
• Oversee authorization processes with commercial payors, Medicaid, and Medicare.
• Maintain MHPAEA and Joint Commission alignment in documentation and workflows.
• Coordinate with Business Office to appeal denied days per contracts.

Skills

Verbal & written communication

UR/claims leadership

Clinical appeals drafting

Payer negotiations

Healthcare regs knowledge

Team leadership

MS Office proficiency

Education

Bachelor's degree

Tools

Microsoft Office

Job description

San Antonio Behavioral Healthcare Hospital is seeking a Director of Utilization Review to oversee UM/UR processes ensuring medical necessity, efficiency, and proper reimbursement. You will lead a team across clinical, finance, and payer interfaces to optimize bed days, manage denials, and ensure compliance with MHPAEA and Joint Commission standards.

The role requires a Bachelor's degree and 5 years in hospital settings with UR/claims experience, plus strong negotiation and documentation skills.