Director of Utilization Review Remote

What you will be doing?
The Director of Utilization Review is responsible for overseeing all utilization review activities to ensure that clients receive appropriate, high-quality, and cost-effective care in alignment with regulatory, payer, and accreditation standards across all Britelife facilities. This role ensures timely and appropriate treatment authorizations at the correct level of care for each client. This individual leads a team of utilization review specialists and works closely with clinical, admissions, and billing departments to ensure that documentation and treatment plans support medical necessity for all levels of care provided. The Director also supports and maintains strong collaboration with facility leadership and staff.

What tasks are required?

• Lead and manage the Utilization Review (UR) department, including hiring, training, supervision, and performance evaluation of UR staff.
• Develop, implement, and maintain effective utilization review policies, workflows, and procedures in compliance with payer requirements, state/federal regulations, and accreditation standards (e.g., Joint Commission, CARF).
• Review and monitor client records to ensure proper documentation of medical necessity and appropriateness of care.
• Serve as primary liaison between the facility and insurance companies or managed care organizations to coordinate authorizations, reviews, continued stay requests, and appeals.
• Collaborate with clinical teams to ensure treatment plans and documentation meet medical necessity criteria and are aligned with individualized care goals.
• Track, analyze, and report utilization trends, denial rates, and authorization outcomes to leadership; implement corrective action plans as needed.
• Participate in interdisciplinary treatment team meetings and provide guidance on medical necessity and documentation best practices.
• Ensure timely submission of initial and concurrent reviews and manage follow-ups for all levels of care (e.g., detox, residential, PHP, IOP).
• Develop training programs to support clinical and UR staff in effective documentation and utilization management.
• Maintain a strong understanding of payer guidelines, industry trends, and regulatory updates affecting utilization review in substance use treatment.
• Respond to incoming calls, emails, and other communications related to new client authorizations.
• Develop and implement standardized forms and processes to ensure consistency across all facilities.
• Partner with medical and clinical staff to improve the accuracy, quality, and completeness of clinical documentation.
• Manage a caseload of clients, coordinating with treatment teams to assess medical necessity and advocate for continued care at the appropriate level.
• Maintain detailed and organized electronic records for all UR activities using internal software systems.
• Monitor length of stay (LOS) data and report findings as required.
• Special projects as assigned

What we need from you?

• Minimum of 5 years of experience in utilization review, case management, or clinical oversight in a behavioral health or substance use treatment setting. At least 2 years in a supervisory or leadership role strongly preferred.
• Experience working with various commercial payers.
• Understanding of billing processes related best practices.
• Strong knowledge of ASAM criteria and DSM-5 diagnostic criteria.
• Ability to manage a team in a fast-paced environment and meet deadlines consistently.
• Excellent organizational, communication, and leadership skills.
• Knowledge of HIPAA regulations and compliance requirements.
• Bachelor's degree in healthcare administration, business, or related field (or equivalent experience).
• Experience or working knowledge with Collaborative MD and KIPU
• Nursing background or healthcare education strongly preferred.
• Ability to lift up to 25 pounds.
• Ability to walk up and down stairs during emergency drills or situations.

All ARS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. ARS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.