Director of Utilization Review & Clinical Strategy

Universal Health Services; Westwood (GA); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Referral Bonus Program

Competitive Compensation & Generous PT

Excellent Medical, Dental, Vision

401(K) with company match

Career development opportunities

Benefits Website access

Job summary

Lighthouse Care Center of Augusta is seeking a dedicated Director of Utilization Review to lead our UR team and integrate patient-centered strategies with high-quality, cost-effective treatment. The role focuses on data collection, analysis, and coordination with insurers to obtain authorizations while aligning with regulatory requirements.

The position emphasizes collaboration with medical staff, timely clinical criteria development, and compliance within a psychiatric care setting.

Qualifications

• Masters degree in a relevant field.
• Minimum of five (5) years direct clinical experience in a psychiatric or mental health treatment setting.
• Experience in managing a related function is preferred.
• Experience in patient assessment, treatment planning and communication with external review organizations or comparable entities.

Responsibilities

• Oversee Utilization Review coordinators as a working manager.
• Participate in treatment team meetings and collaborate with physicians, therapists, nurses and staff.
• Authorize initial precertification and continued authorization with entities.
• Ensure timely gathering and communication of clinical criteria and entry into systems (Midas).
• Coordinate with treatment services to align patient care with regulatory requirements.

Skills

Leadership

Utilization review

Team coordination

External review communications

Education

Masters Degree in nursing, social work, mental health counseling, or related field

Tools

Midas

Job description

Lighthouse Care Center of Augusta is seeking a dedicated Director of Utilization Review to lead our UR team and integrate patient-centered strategies with high-quality, cost-effective treatment. The role focuses on data collection, analysis, and coordination with insurers to obtain authorizations while aligning with regulatory requirements.

The position emphasizes collaboration with medical staff, timely clinical criteria development, and compliance within a psychiatric care setting.