Strategic Director of Utilization Review

New Vista Behavioral Health; Cincinnati (OH); On-site; USD 78,000 - 100,000; Full time

Job summary

New Vista Behavioral Health in Blue Ash, OH seeks an experienced Corporate Director of Utilization Review to lead the organization’s UR program and ensure clinically appropriate, timely, and financially responsible utilization of behavioral health services.

The role partners with clinical, operations, revenue cycle, quality, compliance, and payer relations teams to optimize authorizations, reduce denials, and support appropriate length of stay and transitions of care.

Qualifications

• Bachelor’s degree in a healthcare field is required.
• Active clinical license or credentials preferred.
• 7+ years in healthcare with UR/UM experience, behavioral health favored.
• 3-5+ years of leadership, preferably multi-site.
• Strong knowledge of payer authorization, denials, and medical necessity.
• Proven success in improving authorization outcomes.
• Analytical, organizational, and communication strengths.
• Experience with EHRs, payer portals, and UR systems.
• Knowledge of InterQual, MCG, ASAM LOCUS is a plus.

Responsibilities

• Lead enterprise-wide Utilization Review program and best practices.
• Develop UR policies, workflows, and quality metrics.
• Oversee initial, concurrent, continued-stay, retrospective reviews.
• Ensure timely submission of information to payers.
• Monitor denials, length of stay, and utilization trends.
• Develop strategies to prevent denials and improve outcomes.
• Oversee peer-to-peer reviews and medical necessity appeals.
• Partner with clinical leadership to document medical necessity.
• Establish UR dashboards and KPIs.
• Collaborate to resolve utilization and reimbursement challenges.
• Maintain regulatory and accreditation compliance.
• Serve as UR subject-matter expert for behavioral health.

Skills

Leadership

Healthcare analytics

Communication

Regulatory knowledge

Project management

Education

Bachelor’s degree in Nursing, Healthcare Administration, Social Work or related

Tools

Healthcare EHRs

Payer portals

UR systems

InterQual/MCG/ASAM LOCUS

Job description

New Vista Behavioral Health in Blue Ash, OH seeks an experienced Corporate Director of Utilization Review to lead the organization’s UR program and ensure clinically appropriate, timely, and financially responsible utilization of behavioral health services.

The role partners with clinical, operations, revenue cycle, quality, compliance, and payer relations teams to optimize authorizations, reduce denials, and support appropriate length of stay and transitions of care.