Director of Utilization Review & Care Coordination

Talentify; Augusta (GA); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Referral Bonus

Comprehensive Benefits

401K with match

Generous PTO

Medical/Dental/Vision

Career development

Job summary

Lighthouse Care Center of Augusta seeks a dedicated Director of Utilization Review to lead the Utilization Review team within its Case Management structure. The role focuses on coordinating a patient-centric therapeutic strategy while ensuring high-quality, cost-effective treatment aligned with UHS standards.

The position requires strong clinical data analysis, collaboration with medical staff, and expertise in negotiating authorizations with insurers to support treatment services.

Qualifications

• Masters level clinical leadership experience in psychiatric/mental health setting.
• Experience communicating with external review organizations or similar entities.

Responsibilities

• Oversee Utilization Review coordinators as a working manager
• Participate in treatment team meetings with physicians, therapists, nurses and staff
• Authorize initial precertifications and ongoing authorizations with payers
• Ensure timely gathering and entry of clinical criteria into Midas and related systems

Skills

Leadership

Clinical experience

Healthcare administration

Education

Master's degree in nursing, social work, mental health counseling, or related field

Tools

Midas

Job description

Lighthouse Care Center of Augusta seeks a dedicated Director of Utilization Review to lead the Utilization Review team within its Case Management structure. The role focuses on coordinating a patient-centric therapeutic strategy while ensuring high-quality, cost-effective treatment aligned with UHS standards.

The position requires strong clinical data analysis, collaboration with medical staff, and expertise in negotiating authorizations with insurers to support treatment services.