Desert Parkway Behavioral Healthcare Hospital logo

Director of Utilization Review

Desert Parkway Behavioral Healthcare Hospital

Las Vegas, NVJobSeen 3w agoSeen in employer's feed today

Evaluate my fit

Most applications go out cold — see where you stand first. No sign-up to start.

Watch jobs like this.

Don't just apply. Show up ready.

Olive works from this exact posting.

At a glance

Compensation
No compensation found
Location
Las Vegas, NV
Work Authorization
Not specified

Olive lists jobs from US employers, including remote roles you can work from the United States.

Requirements

Credentials this posting asks for.

Active Clinical License (RN, LCSW, LMFT, LPC)

Job overview

The Director of Utilization Review leads the UR department, overseeing daily operations, team management, and coordination with clinical staff, physicians, and insurers to ensure appropriate care, compliance, and proper reimbursement while handling appeals and preventing claim denials.

Skills & qualifications

RequiredNice to have

Skills

Clinical LicenseMedical Necessity Criteria UnderstandingHealthcare Utilization Management

Qualifications

Active Clinical License (RN, LCSW, LMFT, LPC)Minimum Five Years Experience in Healthcare Utilization Management/ReviewMinimum Three Years Supervisory or Management ExperienceBehavioral Health Setting Experience

Benefits

Medical Insurance
Dental Insurance
Vision Insurance
401(k) Match
Paid Time Off

Full job description

The Director of Utilization Review manages the day-to-day operations of our Utilization Review (UR) department. You will lead a team that tracks authorized care, monitors lengths of stay, and ensures that clinical documentation supports medical necessity. You act as the main bridge between our clinical staff, medical providers, and external insurance payers.

Key Responsibilities

  • Lead the daily work of the utilization review team and monitor the use of hospital services.

  • Direct concurrent, continued stay, and retrospective medical record reviews.

  • Work to prevent avoidable claim denials and handle clinical appeals and peer-to-peer reviews.

  • Partner with physicians, therapists, nursing staff, and the revenue cycle team to prevent delays in care and support proper reimbursement.

  • Keep the department aligned with state, federal, accreditation, and insurance payer rules.

  • Monitor the appropriateness of hospital admissions and extended hospital stays.

  • Prepare and submit appeals to third party payors.

  • Manage hiring, training, mentoring, and performance management for UR staff.

Requirements

  • Active clinical license (RN, LCSW, LMFT, LPC) required.

  • Minimum five (5) years of experience in healthcare utilization management/review, preferably in a behavioral health setting.

  • Minimum three (3) years of supervisory or management experience required.

  • Strong understanding of medical necessity criteria and local insurance payer guidelines.

Benefits

A full benefits package is available the first of the month following 30 days of employment!

Desert Parkway offers competitive benefits to include:

  • 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 (including plans for spouse and children)

  • Short- and long-term disability (with additional buy-in opportunities)

  • Pet Insurance

  • Identity Theft Insurance

Similar jobs, posted recently

Open roles like this one, listed in the last 30 days.

You've read the whole posting — now see how you match it.

Evaluate my fit