Utilization Review Director: Clinical & Payer Leader

Desert Parkway Behavioral Healthcare Hospital; Las Vegas (NV); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Medical insurance

401K Retirement Plan

PTO with holiday premium pay

Vision insurance

Job summary

Desert Parkway Behavioral Healthcare Hospital is seeking a Director of Utilization Review to lead the UR team, monitor care lengths, and ensure medical necessity is well documented. You will bridge clinical staff, providers, and payers to optimize reimbursement and patient outcomes.

The role requires an active clinical license and at least five years in utilization management, with a minimum of three years in supervision.

Qualifications

• Active clinical license required.
• Minimum five years in healthcare utilization management/review, preferably in behavioral health.
• Minimum three years of supervisory or management experience.

Responsibilities

• Lead the daily work of the utilization review team and monitor hospital services use.
• Direct concurrent, continued stay, and retrospective medical record reviews.
• Prevent avoidable claim denials and handle clinical appeals and peer-to-peer reviews.
• Collaborate with physicians, therapists, nursing staff, and revenue cycle team to prevent delays in care and support reimbursement.
• Ensure compliance with state, federal, accreditation, and payer rules.

Skills

Leadership

Utilization management

Clinical documentation

Medical necessity

Staff supervision

Education

RN License

LCSW

LMFT

LPC

Job description

Desert Parkway Behavioral Healthcare Hospital is seeking a Director of Utilization Review to lead the UR team, monitor care lengths, and ensure medical necessity is well documented. You will bridge clinical staff, providers, and payers to optimize reimbursement and patient outcomes.

The role requires an active clinical license and at least five years in utilization management, with a minimum of three years in supervision.