Utilization Review Director

Lifepoint Health • Georgetown, TX

10h • Onsite

About The Position

Rock Springs is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Utilization Review Director joining our team, you’re embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve. At Rock Springs Behavioral Hospital, we are committed to delivering compassionate, high-quality behavioral healthcare while creating an environment where our team members thrive. We are seeking a Director of Utilization Review to provide leadership and oversight for the Utilization Review department, ensuring timely authorization of services, effective payer communication, and strong collaboration across clinical and business functions. This is an excellent opportunity for a driven leader who is passionate about operational excellence, payer relations, and supporting patient access to medically necessary behavioral health services.

Requirements

• Bachelor’s degree in healthcare, business, nursing, or related field preferred.
• Current clinical licensure or RN strongly preferred.
• Minimum of 3 years of utilization review experience in a healthcare setting required.
• Behavioral health or psychiatric hospital UR experience strongly preferred.
• Prior supervisory or leadership experience preferred.
• Experience working with managed care organizations, appeals, and payer authorization processes required.

Responsibilities

• Oversee the day-to-day operations of the Utilization Review department to ensure that all precertifications, recertifications, peer-to-peer reviews, and appeals are completed accurately and within required timeframes.
• Monitor authorization status for current patients, communicate reimbursement risks to executive leadership, and ensure staff adherence to departmental and facility standards.
• Work collaboratively with physicians, nursing, admissions, case management, business office, and corporate teams to maximize reimbursement opportunities while maintaining a patient-centered approach.
• Lead and oversee all Utilization Review functions for inpatient and outpatient services.
• Ensure timely completion of precertifications, concurrent reviews, recertifications, peer-to-peer reviews, and appeals.
• Supervise UR staff performance, workflow, productivity, and compliance with department standards.
• Monitor payer authorization status and communicate denials, risks, and appeal outcomes to leadership.
• Participate in treatment team meetings to gather clinical information and communicate payer requirements.
• Partner with physicians and nursing leadership to ensure documentation supports medical necessity criteria.
• Coordinate peer-to-peer reviews with providers and insurance payers.
• Track, trend, and report denials and identify opportunities for improvement.
• Collaborate with Business Office and CBO teams to support clean claims and reimbursement optimization.
• Educate clinical and administrative staff on payer requirements, authorization processes, and documentation standards.
• Support implementation of UR best practices across the organization.
• Participate in Administrator on Call rotation.
• Promote a culture of accountability, teamwork, and service excellence.

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