Utilization Review Director: Lead Care, Compliance & Appeals

Desert Parkway; Las Vegas (NV); Hybrid; USD 120.000 - 180.000; Vollzeit

Benefits dieser Stelle

Medical insurance

Dental insurance

Vision insurance

401K Retirement Plan

Healthcare spending account

Dependent care spending account

PTO Plan with holiday premium pay

Discounted cafeteria meal plan

Life insurance

Short- and long-term disability

Pet Insurance

Identity Theft Insurance

Zusammenfassung

Desert Parkway is seeking a Director of Utilization Review to lead our UR department in Las Vegas. You will oversee daily operations, monitor care lengths, and ensure documentation supports medical necessity, serving as the liaison between clinical staff, providers, and payers.

You will direct reviews, manage staff, and ensure compliance with payer rules while coordinating with physicians, therapists, and revenue cycle to prevent delays and support appropriate reimbursement.

Qualifikationen

• Active clinical license (RN, LCSW, LMFT, LPC) required.
• Minimum five (5) years of healthcare utilization management/review experience.
• Minimum three (3) years of supervisory or management experience.

Aufgaben

• Lead the utilization review team and monitor hospital services usage.
• Direct concurrent, continued stay, and retrospective medical record reviews.
• Handle clinical appeals, peer-to-peer reviews, and prevent denials.
• Collaborate with physicians, therapists, nursing staff, and revenue cycle to prevent delays and support reimbursement.
• Ensure UR aligns with state, federal, accreditation, and payer rules.
• Monitor appropriateness of admissions and extended stays.
• Prepare and submit appeals to third-party payors.
• Manage hiring, training, and performance of UR staff.

Kenntnisse

Leadership

Utilization management

Team supervision

Ausbildung

Active clinical license (RN, LCSW, LMFT, LPC)

Jobbeschreibung

Desert Parkway is seeking a Director of Utilization Review to lead our UR department in Las Vegas. You will oversee daily operations, monitor care lengths, and ensure documentation supports medical necessity, serving as the liaison between clinical staff, providers, and payers.

You will direct reviews, manage staff, and ensure compliance with payer rules while coordinating with physicians, therapists, and revenue cycle to prevent delays and support appropriate reimbursement.