Strategic Utilization Review Lead

Odyssey-Behavioral-Healthcare; Franklin (TN); On-site; USD 85,000 - 110,000; Full time

Job summary

Odyssey Behavioral Healthcare, LLC, is seeking a Manager of Utilization Review to lead UR operations across an assigned division, ensuring timely initial, concurrent, and retrospective reviews with accuracy. You will guide and educate UR Coordinators, collaborate with nursing leadership and the Revenue Cycle team, and act as a subject matter expert to optimize denials prevention and compliance.

This leadership role requires a bachelor’s degree and at least three years’ external review experience

Qualifications

• Bachelor’s degree or equivalent in related field.
• Minimum three years' experience with external review organizations.
• Experience with pre-certification, concurrent, and retrospective reviews.

Responsibilities

• Communicates professionally with multidisciplinary teams and insurance organizations.
• Manages hiring, onboarding, and supervision of UR Coordinators.
• Provides fair leadership and supports team development.
• Performs medical records reviews and ongoing clinical training.
• Maintains knowledge of UR processes, denials, and concurrent reviews.
• Audits UR Coordinator work to ensure quality and performance.
• Escalates challenges to Director of Utilization Review as needed.

Skills

Medical terminology

Behavioral health terminology

Problem solving

Analytical skills

Discretion

Conflict management

Time management

Organizational skills

Communication skills

Team collaboration

Microsoft Office

Education

Bachelor's degree or equivalent

Tools

Microsoft Office

Job description

Odyssey Behavioral Healthcare, LLC, is seeking a Manager of Utilization Review to lead UR operations across an assigned division, ensuring timely initial, concurrent, and retrospective reviews with accuracy. You will guide and educate UR Coordinators, collaborate with nursing leadership and the Revenue Cycle team, and act as a subject matter expert to optimize denials prevention and compliance.

This leadership role requires a bachelor’s degree and at least three years’ external review experience