VP of Utilization Review

🕒 Junho 30

🎸 Tennessee – Remoto

🎸 Tennessee – Remote

⏰ Tempo Integral

🔴 Especialista

👔 Vice-presidente

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Odyssey Behavioral Healthcare

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2015

💼 Consultoria

🏥 Saúde

🧘 Bem-estar

Consulting • Healthcare • Wellness

A Odyssey Behavioral Healthcare oferece tratamento personalizado e baseado em evidências para adolescentes e adultos de todos os gêneros que enfrentam transtornos alimentares, transtornos mentais e transtornos por uso de substâncias. Nosso abrangente contínuo de cuidados inclui programas residenciais, de hospitalização parcial e ambulatoriais intensivos, projetados para atender os clientes onde quer que estejam em sua jornada de recuperação.

Descrição

• Provides executive oversight and strategic direction for all enterprise Utilization Review operations across multiple facilities, service lines, and states. • Develops and implements standardized enterprise-wide UR processes, workflows, policies, and documentation standards to improve operational consistency and payer outcomes. • Oversees authorization management, concurrent review processes, denial prevention strategies, appeals management, retrospective reviews, and payer escalation processes. • Partners with Clinical, Nursing, Admissions, and Revenue Cycle teams to ensure documentation supports medical necessity, level of care determinations, and reimbursement optimization. • Develops enterprise KPI dashboards and reporting structures related to denials, overturn rates, authorization timeliness, payer trends, reimbursement performance, length of stay management, and utilization efficiency. • Identifies trends, gaps, and opportunities within utilization management processes and leads performance improvement initiatives to enhance operational and financial outcomes. • Collaborates with executive leadership regarding payer contracting strategy, authorization challenges, network access issues, and value-based care initiatives. • Serves as an organizational expert regarding payer requirements, medical necessity criteria, utilization management regulations, and behavioral health reimbursement practices. • Oversees recruitment, onboarding, training, mentorship, performance management, and leadership development for enterprise UR leadership and staff. • Conducts regular audits and quality reviews to ensure compliance with regulatory requirements, payer expectations, and organizational standards. • Leads enterprise education initiatives related to documentation integrity, medical necessity standards, payer trends, and authorization best practices. • Collaborates with Information Technology and EHR leadership to optimize utilization review workflows, reporting capabilities, automation opportunities, and data integrity. • Supports organizational growth initiatives, acquisitions, new program development, and expansion strategies through scalable utilization management processes. • Participates in executive meetings, operational reviews, and strategic planning initiatives as a key organizational leader. • Maintains strict confidentiality of all company, departmental, patient, payer, and healthcare provider information. • Reports enterprise risks, payer concerns, and operational barriers to executive leadership with recommendations for resolution and mitigation.

🎯 Requisitos

• Bachelor’s degree required • Master’s degree in nursing, Healthcare Administration, Business Administration, or related healthcare field preferred • Clinical licensure preferred (RN, LCSW, LPC, LMFT, or comparable behavioral health licensure) • Requires a minimum of 7 years of progressive Utilization Review leadership experience within behavioral health, including large multi-site or enterprise oversight responsibilities • Previous experience developing KPIs, reporting analytics, dashboards, and executive-level operational presentations is required.

🏖️ Benefícios

• Equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. • Reasonable accommodations may be made to reasonably accommodate qualified individuals with disabilities.