Director, Utilization Review

🔥 0 minutes ago

🎸 Mississippi – Remote

🎸 Mississippi – Remote

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 10%

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Bradford Health Services

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1977

🏥 Healthcare

🧘 Wellness

🤝 Non-profit

Healthcare • Wellness • Non-profit

Bradford Health Services is a leading provider of addiction treatment programs, offering a wide range of services to support individuals in their recovery journey. With facilities across the Southeast, they provide inpatient and outpatient rehabilitation, detox services, and various specialty programs tailored to meet the unique needs of their patients. Their commitment to affordable, evidence-based treatment ensures that individuals can access the support they need to reclaim their lives from addiction.

📋 Description

• Lead and manage the utilization review department, ensuring timely and accurate clinical reviews in accordance with regulatory and accreditation standards • Develop and implement policies, procedures, and protocols to standardize utilization management practices across the organization • Collaborate with clinical teams, case managers, and external payers to facilitate appropriate care delivery and resolve utilization-related issues • Analyze utilization data and trends to identify opportunities for process improvements and cost containment • Provide training, mentorship, and performance evaluations for utilization review staff • Ensure adherence to federal, state, and payer regulations related to utilization review and healthcare compliance • Serve as a subject matter expert during audits, accreditation surveys, and internal reviews • Partner with quality improvement and risk management teams to integrate utilization review findings into broader organizational initiatives • Act as a liaison between clinical staff, payers, and leadership to align utilization review activities with organizational goals and healthcare best practices

🎯 Requirements

• Bachelor’s degree in Nursing, Health Administration, or a related healthcare field • Minimum of 5 years of progressive experience in utilization review, case management, or healthcare operations • Strong knowledge of healthcare regulations, payer policies, and accreditation standards related to utilization review • Demonstrated ability to analyze clinical data and implement process improvements • Master’s degree in Nursing, Healthcare Administration, Public Health, or a related field preferred • Leadership experience managing clinical teams in a utilization management or related environment preferred • Certification in Case Management (CCM), Utilization Review (URAC), or related professional credentials preferred • Experience working within managed care organizations or health insurance companies preferred • Proficiency with healthcare data analytics tools and electronic health record (EHR) systems preferred • Familiarity with value-based care models and population health management preferred

🏖️ Benefits

• Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits • Expanded Coverage – Options for domestic partners and a wider network of in-network providers • Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching • Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more • Student Loan Repayment – Available for nurses and therapists • Retirement Benefits – 401(k) plan through Voya • Generous PTO – Robust paid time off policy • Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week • Great Place To Work® Certification and supportive, rewarding workplace culture