Regional Director of Utilization Management

Provide regional operational leadership for Utilization Management across assigned facilities, directly supervising Utilization Review Managers and establishing accountability for quality, productivity, and financial performance. Ensure consistent implementation of enterprise standards while monitoring staffing levels and workload distribution to optimize patient outcomes. Oversee initial authorization and concurrent review activities, ensuring timely clinical documentation submission and minimizing care interruptions. Collaborate with clinical teams to maximize medically appropriate authorized days, escalate complex authorization issues, and promote accurate documentation supporting medical necessity. Partner with physicians to improve documentation quality, monitor trends related to denials, and oversee appeal strategies. Build collaborative relationships with payer representatives, participate in operational reviews, and develop regional action plans based on identified trends. Monitor key metrics including authorization approval rates, timeliness, denial rates, and revenue at risk to drive continuous process improvement.