Senior Utilization Review Lead

Odyssey Behavioral Group

Franklin (TN)

On-site

USD 90,000 - 120,000

Full time

14 days+

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Job summary

Odyssey Behavioral Healthcare, LLC in Franklin, TN is seeking an experienced Manager of Utilization Review to lead daily UR operations across a division. You will drive timely reviews—initial, concurrent, and retrospective—with accuracy, support denial prevention, ensure regulatory compliance, and optimize processes.

You will act as an internal subject matter expert and frontline people leader guiding UR staff.

Qualifications

Bachelor's degree or equivalent in combined education and experience.
Minimum of three (3) years’ experience with external review organizations or comparable entities doing pre-certification and concurrent reviews.
Experience in mental health, substance abuse, and/or eating disorder facilities is preferred.

Responsibilities

Communicates professionally with multidisciplinary teams, insurance organizations, and business offices, using technical language that describes client needs.
Manages hiring, onboarding, training, and supervision of Utilization Review Coordinators.
Assists team members with challenging cases to increase access to care.
Performs medical records reviews with clinical teams.
Performs regular audits of UR Coordinators’ work for quality and performance.
Maintains knowledge of UR processes, including denials and concurrent reviews.
Revises processes with the Director of Utilization Review to meet goals.
Maintains strong documentation standards and confidentiality.
Escalates challenges to the Director for resolution.