Strategic Director, Utilization Review & Payer Relations

Ispn Psych; United States; On-site; USD 130,000 - 169,000; Full time

Job summary

Cincinnati Children’s is seeking a Director of Utilization Review at the South Campus. The role leads utilization review and revenue cycle activities, ensuring payer approvals for inpatient admissions and stays while aligning with JCAHO, Medicaid, and Medicare standards.

The position requires an Ohio RN license, a bachelor’s in nursing, and extensive management experience. The role oversees payer communications, educational initiatives, and financial management responsibilities within a 40-hour,

Qualifications

• Bachelor’s degree in nursing and Ohio RN license.
• 5+ years in a related job discipline.
• 4 years frontline management experience.

Responsibilities

• Lead utilization review functions to secure approvals for inpatient admissions and continued stays.
• Coordinate with third-party payers to certify inpatient stays and challenge adverse determinations when needed.
• Support revenue cycle by communicating with Medicaid/Medicare and other third-party reviewers and assist with denials appeals.

Skills

Leadership

Utilization Review

Healthcare Management

Payer Relations

Education

Bachelor’s degree in nursing

Job description

Cincinnati Children’s is seeking a Director of Utilization Review at the South Campus. The role leads utilization review and revenue cycle activities, ensuring payer approvals for inpatient admissions and stays while aligning with JCAHO, Medicaid, and Medicare standards.

The position requires an Ohio RN license, a bachelor’s in nursing, and extensive management experience. The role oversees payer communications, educational initiatives, and financial management responsibilities within a 40-hour,