Director of Utilization Review Rock Springs is part of Lifepoint Health, a diversified healthcare delivery network. 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. Key Responsibilities 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. Education and Experience Bachelor's degree in healthcare, business, nursing, or related field preferred. Current clinical licensure or RN strongly preferred. 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. Benefits 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. EEOC Statement Rock Springs is 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. #J-18808-Ljbffr