Regional Director – Utilization Management

Jobtailor; Birmingham (AL); On-site; USD 120,000 - 180,000; Full time

Job summary

Jobtailor is seeking a regional leader in Utilization Management to oversee operations across assigned facilities, supervise UR managers, and ensure adherence to enterprise standards. The role emphasizes accountability for quality, productivity, and financial performance while maintaining timely documentation for payers.

The position requires extensive experience in UM operations, concurrent review, and payer authorizations, with collaboration across clinical teams to maximize medically

Qualifications

• Bachelor's degree in a healthcare field required.
• 7+ years in Utilization Management, Case Management, Revenue Cycle, or Behavioral Health leadership.
• 3+ years leading multi-site teams.
• Experience with concurrent review, medical necessity, payer authorizations, appeals, and UM operations.
• Strong knowledge of commercial, Medicare, Medicaid, and VA authorization requirements.

Responsibilities

• Provide regional operational leadership for Utilization Management across assigned facilities.
• Directly supervise Utilization Review Managers.
• Establish accountability for quality, productivity, timeliness, and financial performance.
• Ensure consistent implementation of enterprise Utilization Management standards.
• Monitor staffing levels and workload distribution to optimize productivity.
• Oversee initial authorization and concurrent review activities.
• Ensure timely submission of clinical documentation to payers.
• Monitor authorization status to minimize interruptions in patient care.
• Collaborate with clinical teams to maximize medically appropriate authorized days.
• Escalate complex authorization issues as appropriate.
• Promote accurate and complete clinical documentation supporting medical necessity.
• Partner with physicians and clinical leadership to improve documentation quality.
• Monitor trends related to authorization denials and documentation deficiencies.
• Collaborate with clinical teams to improve documentation practices.
• Oversee appeal strategy for medical necessity denials.
• Support peer-to-peer review processes.
• Identify payer trends and develop regional action plans.
• Build collaborative relationships with payer representatives.
• Participate in payer meetings and operational reviews.
• Monitor regional performance metrics including: Authorization approval rate Initial authorization timeliness Continued stay (concurrent review) approval rate Medical necessity denial rate Appeal overturn rate Average approved Length of Stay Revenue at Risk Productivity Quality audit scores Develop corrective action plans when performance targets are not achieved.

Skills

Utilization Management Leadership

Concurrent Review Management

Medical Necessity Expertise

Payer Authorization Knowledge

Behavioral Health Experience

Education

Bachelor's Degree in Nursing

Bachelor's Degree in Healthcare Administration

Bachelor's Degree in Health Information Management

Bachelor's Degree in Social Work

Job description

• Provide regional operational leadership for Utilization Management across assigned facilities.
• Directly supervise Utilization Review Managers.
• Establish accountability for quality, productivity, timeliness, and financial performance.
• Ensure consistent implementation of enterprise Utilization Management standards.
• Monitor staffing levels and workload distribution to optimize productivity and patient outcomes.
• Oversee initial authorization and concurrent review activities.
• Ensure timely submission of clinical documentation to payers.
• Monitor authorization status to minimize interruptions in patient care.
• Collaborate with clinical teams to maximize medically appropriate authorized days.
• Escalate complex authorization issues as appropriate.
• Promote accurate and complete clinical documentation supporting medical necessity.
• Partner with physicians and clinical leadership to improve documentation quality.
• Monitor trends related to authorization denials and documentation deficiencies.
• Collaborate with clinical teams to improve documentation practices.
• Oversee appeal strategy for medical necessity denials.
• Support peer-to-peer review processes.
• Identify payer trends and develop regional action plans.
• Build collaborative relationships with payer representatives.
• Participate in payer meetings and operational reviews.
• Monitor regional performance metrics including: Authorization approval rate Initial authorization timeliness Continued stay (concurrent review) approval rate Medical necessity denial rate Appeal overturn rate Average approved Length of Stay Revenue at Risk Productivity Quality audit scores Develop corrective action plans when performance targets are not achieved.

Requirements

• Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, Social Work, or related healthcare field required.
• Minimum seven (7) years of progressive Utilization Management, Case Management, Revenue Cycle, or Behavioral Health leadership experience.
• Minimum three (3) years leading multi-site teams.
• Demonstrated Behavioral Health and/or substance use disorder (SUD) treatment experience required.
• Experience managing concurrent review, medical necessity, payer authorizations, appeals, and utilization management operations.
• Strong knowledge of commercial, Medicare, Medicaid, and VA authorization requirements.

Core Competencies

Demonstrates extensive experience in Utilization Management, including oversight of authorization processes, clinical documentation, and performance metrics. Proven ability to lead multi-site teams and collaborate with clinical and payer representatives to enhance patient care and operational efficiency.

Highest-signal resume keywords

• Utilization Management Leadership
• Concurrent Review Management
• Medical Necessity Expertise
• Payer Authorization Knowledge
• Behavioral Health Experience

ATS Optimization Keywords

Hard Skills

• Utilization Management
• Concurrent Review
• Medical Necessity
• Payer Authorizations
• Appeals Management
• Quality Audits
• Performance Metrics Monitoring
• Corrective Action Planning
• Clinical Documentation Improvement
• Revenue Cycle Management

Soft Skills

• Collaborative Leadership
• Relationship Building
• Accountability
• Problem Solving
• Communication

Certifications & Qualifications

• Bachelor's Degree in Nursing
• Bachelor's Degree in Healthcare Administration
• Bachelor's Degree in Health Information Management
• Bachelor's Degree in Social Work

Industry Keywords

• Commercial Authorization
• Medicare Authorization
• Medicaid Authorization
• VA Authorization
• Substance Use Disorder Treatment