Utilization Review Director

Your experience matters 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. Lead with purpose. Drive outcomes. Support life-changing care. 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.

What You'll Do:

The Director of Utilization Review is responsible for overseeing 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. This leader will monitor authorization status for current patients, communicate reimbursement risks to executive leadership, and ensure staff adherence to departmental and facility standards. The Director works 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 What we're looking for

Education:

Bachelor's degree in healthcare, business, nursing, or related field preferred. Current clinical licensure or RN strongly preferred.

Experience:

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 Why join us We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:

Comprehensive Benefits :

Multiple levels of medical, dental and vision coverage for full-time and part-time employees.

Financial Protection & PTO :

Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.

Financial & Career Growth :

Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.

Employee Well-being :

Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).

Professional Development :

Ongoing learning and career advancement opportunities. More about Rock Springs Rock Springs is a 35 bed behavioral health hospital that has been offering exceptional care to the Texas community for over 5 years. EEOC Statement Rock Springs an Equal Opportunity Employer. Rock Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment." We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.