Division Director, Utilization Review at Lifepoint Health

Louisville, Kentucky, United States -

Full Time

Start Date

Immediate

Expiry Date

04 Aug, 26

Salary

0.0

Posted On

06 May, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Review, Appeals Management, Clinical Documentation, Regulatory Compliance, Data Analysis, Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Payer Communication, Medical Necessity Criteria, Case Management, Reporting, Staff Training, Budgeting, Healthcare Administration, Peer-to-Peer Review

Industry

Hospitals and Health Care

Description

Schedule: Days: M-F Job Location Type: Hybrid Your experience matters At Lifepoint Health, 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. As a member of the Health Support Center (HSC) team, you’ll support those that are in our facilities who are interfacing and providing care to our patients and community members to positively impact our mission of making communities healthier ®. More about our team The Division Director of Utilization Review partners closely with the Division Vice President of Finance to ensure all utilization review and management activities are completed accurately, efficiently, and in full compliance with regulatory requirements. This includes oversight of precertification and recertification processes, peer‑to‑peer reviews, and appeals management. The Division Director provides regular reporting on authorization status, clinical documentation quality, denial trends, and appeals outcomes to facility leadership and the Health Support Center (HSC). How you’ll contribute A Division Director of Utilization Review who excels in this role: * Develops and maintains facility and HSC reports, tracking key utilization review indicators and shares findings with leadership. * Ensures hospital utilization review departments complete all inpatient and outpatient pre‑certifications and re‑certifications. * Manages appeals and trains facility staff on the appeals process. * Collaborates with medical staff to ensure timely completion of peer reviews and physician‑to‑physician reviews. * Provides education on coverage requirements and gathers information needed for payer communication. * Trains facility staff on documentation standards, medical necessity criteria, and utilization review expectations. * Works closely with clinical teams to ensure documentation meets regulatory and payer requirements. * Supports Directors of Utilization Review to ensure timely, thorough, and accurate completion of appeals. * Interfaces with Business Office and external payers to address and resolve denials. * Ensures accurate, timely tracking and reporting of denials and outcomes across facilities. * Provides proctoring and onboarding support for staff at new or existing facilities. * Demonstrates strong data collection, excel proficiency, and analytical skills to support utilization review operations. * Oversees the utilization review department, ensuring staff meet performance expectations and complete assignments. * Monitors hospital length of stay, reports trends, and educates utilization review staff. * Participates in treatment team processes to ensure teams remain informed of coverage requirements and payer communication needs. * Always exhibit the company’s core values of champion patient care, do the right thing, embrace individuality, act with kindness, and making a difference together. 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. What we’re looking for * Bachelor’s degree in Counseling, Social Work, Nursing, or related clinical field from an accredited school required. Master’s degree in clinical field from an accredited school preferred. * Five years of progressive utilization review experience required. * Counseling, Social Work, or Registered Nurse license preferred. * Multi-facility/Regional oversight of behavioral healthcare facilities preferred. * Proficiency in using technology, including Microsoft Word, Excel and PowerPoint. * Ability to travel up to 50% by land and/or air. EEOC Statement “Lifepoint Health is an Equal Opportunity Employer. Lifepoint Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.” You must be authorized to work in the United States without employer sponsorship. 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. 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.

Responsibilities

Oversees utilization review and management activities to ensure regulatory compliance and efficiency across multiple facilities. Partners with leadership to track denial trends, manage appeals, and provide clinical documentation training to staff.