Strategic Director of Utilization Review & Payer Outcomes

New Vista Behavioral Health; Cincinnati (OH); Presencial; USD 78 000 - 100 000; Tempo integral

Resumo da oferta

New Vista Behavioral Health in Blue Ash, OH seeks an experienced Corporate Director of Utilization Review to lead UR programs across the organization and ensure clinically appropriate, timely, and financially responsible care. You will align clinical, operations, revenue cycle, and payer relations to optimize authorizations and transitions.

The role requires 7+ years in healthcare with UR/management, leadership across multi-site settings, and expertise in payer processes, as well as knowledge of

Qualificações

• Bachelor’s degree in Nursing, Healthcare Administration, Social Work, Psychology, or related field.
• Active clinical license preferred.
• 7+ years of healthcare experience including behavioral health utilization review/management.
• 3-5+ years of leadership in multi-site or corporate environments.
• Strong knowledge of medical necessity, payer authorization, and denials.
• Experience with UR standards including InterQual, MCG, LOCUS is a plus.

Responsabilidades

• Lead enterprise-wide Utilization Review program and establish best practices.
• Develop UR policies, workflows, and quality metrics.
• Oversee initial, concurrent, continued-stay, retrospective, and discharge reviews.
• Ensure timely submission of information to payers and organizations.
• Monitor outcomes, denials, length of stay, and trends.
• Collaborate with leaders to improve documentation and transitions of care.
• Oversee peer-to-peer reviews and medical necessity appeals.
• Provide coaching to facility UR teams and managers.
• Maintain compliance with regulatory and payer requirements.

Conhecimentos

Leadership

Strategic thinking

Communication

Analytical skills

Formação académica

Bachelor's degree

Ferramentas

EHR systems

Payer portals

Utilization management systems

InterQual/MCG criteria

Descrição da oferta de emprego

New Vista Behavioral Health in Blue Ash, OH seeks an experienced Corporate Director of Utilization Review to lead UR programs across the organization and ensure clinically appropriate, timely, and financially responsible care. You will align clinical, operations, revenue cycle, and payer relations to optimize authorizations and transitions.

The role requires 7+ years in healthcare with UR/management, leadership across multi-site settings, and expertise in payer processes, as well as knowledge of