Director, Utilization Review

Director, Utilization Review

At Denver Springs Hospital, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

The responsibility of the UR Director is to ensure the utilization review activities are completed accurately and timely. This includes the precertification and recertification, peer to peer process, and appeals. The UR Director will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals. The Director will ensure that all UR staff members follow department and facility procedures. The Director will further ensure that communication with all relevant departments, but especially CBO and Business Office, meets staff and patient needs. The UR Director will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals.

Oversees the UR department, ensuring staff has completed all assignments and monitors performance.

Ensures all pre-certifications are completed for inpatient and outpatient services.

Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the CEO or delegate.

Be available to educate staff members from other relevant departments on documentation requirements / medical criteria and does so in a professional, organized, and understandable manner.

Works with DON to ensure documentation requirements are met.

Ensure appeals are completed thoroughly and on a timely basis.

Interface with managed care organizations, external reviews, and other payers.

Participates in Administrator on Call rotation

Communicate with physicians to schedule peer to peer reviews.

Accurately report denials.

Is available to proctor staff members at other Springstone facilities on relevant policies and procedures.

Education : Bachelor's degree required. Master's degree preferred.

Experience : Previous utilization review experience in a psychiatric healthcare facility preferred.

License : Current unencumbered clinical license strongly preferred.

Additional Requirements : CPI and CPR preferred within 30 days of hire. May be required to work flexible hours.

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers :

Comprehensive medical, dental, and vision plans, plus flexible-spending and health-savings accounts

Competitive paid time off and extended illness bank package for full-time employees

Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage

Tuition reimbursement, loan assistance, and 401(k) matching

Employee assistance program including mental, physical, and financial wellness

Professional development and growth opportunities

Denver Springs is located in Englewood, CO and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestoneyour experience matters

Denver Springs is an Equal Opportunity Employer. Denver Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.