Director, Utilization Review

Job Title: Director, Utilization Review
Job Type: FT, On-site, Monday-Friday 8am-5pm MST

Your experience matters Denver Springs Hospital

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.

How you'll contribute

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.

Job Details

• 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.
• 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.

Qualifications and requirements

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.

About Us Denver Springs
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 milestone-your experience matters

EEOC Statement

"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."

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.