Director of Utilization Review: Clinical Ops & Payer

Desert Parkway Behavioral Healthcare Hospital; Las Vegas (NV); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401K Retirement Plan

Healthcare spending account

Dependent care spending account

PTO with holiday premium pay

Discounted cafeteria meal plan

Life insurance

Job summary

Desert Parkway Behavioral Healthcare Hospital seeks a Director of Utilization Review to lead the UR team, oversee monitoring of authorized care, length of stay, and ensure medical necessity documentation aligns with payer requirements.

You will bridge clinical staff, medical providers, and external insurers, guiding reviews and appeals while ensuring compliance with all applicable regulations.

Qualifications

• Active clinical license required (RN, LCSW, LMFT, or LPC).
• 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.

Responsibilities

• Lead the daily operations 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.

Skills

Utilization review

Team leadership

Clinical collaboration

Medical necessity

Education

Active clinical license (RN, LCSW, LMFT, LPC)

Job description

Desert Parkway Behavioral Healthcare Hospital seeks a Director of Utilization Review to lead the UR team, oversee monitoring of authorized care, length of stay, and ensure medical necessity documentation aligns with payer requirements.

You will bridge clinical staff, medical providers, and external insurers, guiding reviews and appeals while ensuring compliance with all applicable regulations.