Division Director, Utilization Review

Lifepoint Health • Louisville, KY

4h • Hybrid

About The Position

The Division Director of Utilization Review partners closely with the Division Vice President of Finance to ensure all utilization review and management activities are completed accurately, efficiently, and in full compliance with regulatory requirements. This includes oversight of precertification and recertification processes, peer‑to‑peer reviews, and appeals management. The Division Director provides regular reporting on authorization status, clinical documentation quality, denial trends, and appeals outcomes to facility leadership and the Health Support Center (HSC).

Requirements

• Bachelor’s degree in Counseling, Social Work, Nursing, or related clinical field from an accredited school required.
• Five years of progressive utilization review experience required.
• Proficiency in using technology, including Microsoft Word, Excel and PowerPoint.
• Ability to travel up to 50% by land and/or air.
• Must be authorized to work in the United States without employer sponsorship.

Nice To Haves

• Master’s degree in clinical field from an accredited school preferred.
• Counseling, Social Work, or Registered Nurse license preferred.
• Multi-facility/Regional oversight of behavioral healthcare facilities preferred.

Responsibilities

• Develops and maintains facility and HSC reports, tracking key utilization review indicators and shares findings with leadership.
• Ensures hospital utilization review departments complete all inpatient and outpatient pre‑certifications and re‑certifications.
• Manages appeals and trains facility staff on the appeals process.
• Collaborates with medical staff to ensure timely completion of peer reviews and physician‑to‑physician reviews.
• Provides education on coverage requirements and gathers information needed for payer communication.
• Trains facility staff on documentation standards, medical necessity criteria, and utilization review expectations.
• Works closely with clinical teams to ensure documentation meets regulatory and payer requirements.
• Supports Directors of Utilization Review to ensure timely, thorough, and accurate completion of appeals.
• Interfaces with Business Office and external payers to address and resolve denials.
• Ensures accurate, timely tracking and reporting of denials and outcomes across facilities.
• Provides proctoring and onboarding support for staff at new or existing facilities.
• Demonstrates strong data collection, excel proficiency, and analytical skills to support utilization review operations.
• Oversees the utilization review department, ensuring staff meet performance expectations and complete assignments.
• Monitors hospital length of stay, reports trends, and educates utilization review staff.
• Participates in treatment team processes to ensure teams remain informed of coverage requirements and payer communication needs.
• Always exhibit the company’s core values of champion patient care, do the right thing, embrace individuality, act with kindness, and making a difference together.

Benefits

• Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Ongoing learning and career advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager