VP of Utilization Review

🕒 il y a 1 mois

🎸 Tennessee – Distant

🎸 Tennessee – Remote

⏰ Temps Plein

🔴 Expert

👔 Vice-président

Postuler Maintenant

Trouver des Emplois à Distance Similaires

Configurer une alerte email pour les nouveaux emplois

📊 Vérifiez votre score de CV pour ce poste

Améliorez vos chances d'obtenir un entretien en vérifiant votre score de CV avant de postuler.

Télécharger le CV

Odyssey Behavioral Healthcare

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 2015

💼 Conseil

🏥 Santé

🧘 Bien-être

Consulting • Healthcare • Wellness

Odyssey Behavioral Healthcare offre des traitements personnalisés et basés sur des preuves pour les adolescents et adultes de tous genres confrontés à des troubles alimentaires, des troubles de santé mentale et des troubles liés à l'usage de substances. Notre continuum de soins complet inclut des programmes résidentiels, d'hospitalisation partielle et de soins intensifs ambulatoires, conçus pour répondre aux besoins des clients à chaque étape de leur parcours de rétablissement. Fondée pour combler l'écart crucial entre l'hospitalisation aiguë et les soins ambulatoires traditionnels, Odyssey fournit un chemin sans faille vers un rétablissement durable. Chaque établissement est soigneusement conçu pour favoriser un rétablissement durable et une réintégration sociale. Des environnements de style complexe hôtelier aux cadres plus domestiques, nos emplacements respectent les normes de sécurité les plus élevées et détiennent des accréditations prestigieuses, dont celles de The Joint Commission et de CARF® International, reflétant notre engagement envers l'excellence clinique et la qualité opérationnelle. En partenariat avec des cliniciens et professionnels à travers le pays, Odyssey soutient les individus et leurs proches grâce à des soins collaboratifs de confiance. Chez Odyssey, nous rencontrons les clients avec empathie, expertise et dévouement afin de les aider à reprendre leur vie en main.

Description

• 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.

🎯 Exigences

• 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.

🏖️ Avantages

• 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.