Utilization Review Lead – Denials Prevention & Compliance

Odyssey Behavioral Healthcare; Franklin (TN); On-site; USD 90,000 - 120,000; Full time

Job summary

Odyssey Behavioral Healthcare seeks a Manager of Utilization Review to oversee daily UR operations for the assigned division. You will lead and coach UR Coordinators, ensuring timely initial, concurrent, and retrospective reviews with accuracy, while collaborating across the organization to support compliance and process optimization.

You will serve as an internal subject matter expert, guiding teams on UR functions, performance metrics, and cross-functional workflows in support of

Qualifications

• Requires a bachelor's degree or equivalent in combined education and experience.
• Minimum of three (3) years' experience with external review organizations or comparable entities doing pre-certification and concurrent reviews in mental health, substance abuse, and/or eating disorder facilities.

Responsibilities

• Manages daily operations of the Utilization Review (UR) practice for the assigned division and leads a team of UR Coordinators.
• Coordinates with leaders across the company to support denial prevention strategies, regulatory compliance and process optimization.
• Performs medical records reviews and ongoing training with clinical/medical team members within the division.
• Maintains current knowledge of UR processes and trends, including denials and concurrent reviews, and revises processes to meet organizational goals.

Education

Bachelor’s degree or equivalent in combined education and experience

Job description

Odyssey Behavioral Healthcare seeks a Manager of Utilization Review to oversee daily UR operations for the assigned division. You will lead and coach UR Coordinators, ensuring timely initial, concurrent, and retrospective reviews with accuracy, while collaborating across the organization to support compliance and process optimization.

You will serve as an internal subject matter expert, guiding teams on UR functions, performance metrics, and cross-functional workflows in support of