Strategic Director of Utilization & Care Optimization

San Antonio Behavioral Healthcare Hospital; San Antonio (TX); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health Insurance

Vision Insurance

Dental Insurance

401K Retirement Plan

Healthcare Spending Account

Dependent Care Spending Account

PTO Plan

Life Insurance

Short and Long-Term Disability

Job summary

San Antonio Behavioral Healthcare Hospital is seeking a Director of Utilization Review to oversee medical necessity determination, LOS management, and payer denials prevention. The role bridges clinical care, hospital finance, and insurers to optimize bed utilization and ensure compliant documentation.

The ideal candidate has a Bachelor's degree in a related field and at least 5 years in hospital UR/claims review, with demonstrated leadership and negotiation skills to coordinate with physicians,

Qualifications

• Bachelor's degree in a related field (e.g., healthcare administration) or equivalent work experience.
• 5 years’ hospital experience with at least 2 in utilization review, claims review, or management review.

Responsibilities

• Design UM strategies to optimize resource allocation and cost-containment.
• Ensure compliance with state/federal healthcare regulations and accrediting bodies.
• Collaborate with insurance companies to resolve disputes and manage LOS approvals.
• Provide documentation training to clinical staff to reflect acuity in records.
• Analyze data to identify bottlenecks, reduce denials, and promote evidence-based practices.
• Oversee authorization processes with commercial payors, Medicaid, and Medicare.
• Ensure documentation aligns with MHPAEA and Joint Commission standards.
• Work with Business Office to appeal denied days within contractual protocols.
• Serve as central liaison among clinical staff, billing, and third-party payers.
• Attend discharge updates and perform other duties as required.

Skills

Verbal communication

Written communication

Negotiation

Data analysis

Leadership

Team management

Documentation

Policy understanding

Education

Bachelor's degree in related field

Tools

Microsoft Office Suite

Job description

San Antonio Behavioral Healthcare Hospital is seeking a Director of Utilization Review to oversee medical necessity determination, LOS management, and payer denials prevention. The role bridges clinical care, hospital finance, and insurers to optimize bed utilization and ensure compliant documentation.

The ideal candidate has a Bachelor's degree in a related field and at least 5 years in hospital UR/claims review, with demonstrated leadership and negotiation skills to coordinate with physicians,