VP of Utilization Review

Position Summary The Vice President of Utilization Review (VP of UR) provides strategic and operational leadership for the enterprise-wide Utilization Review function across all behavioral health service lines and levels of care. This executive leader is responsible for developing, standardizing, optimizing, and overseeing utilization management practices that support quality care, appropriate reimbursement, regulatory compliance, payer relationships, and organizational financial performance. The VP of UR partners closely with Executive Leadership, Clinical Operations, Revenue Cycle, Admissions, Nursing, Compliance, Business Development, and Finance to ensure utilization management processes align with organizational goals, evidence-based practices, and payer requirements. This role is responsible for driving performance improvement initiatives related to authorizations, denials management, length of stay optimization, appeals, documentation integrity, and payer strategy. The VP of UR serves as the enterprise subject matter expert for utilization management and develops scalable systems, reporting structures, KPIs, and accountability processes to support continued organizational growth and operational excellence. Relationships and Contacts Within the organization: Maintains frequent and collaborative working relationships with the Chief Clinical Officer, Executive Leadership, Divisional CEOs, Chief Financial Officer, Revenue Cycle leadership, Business Development, Admissions, Nursing leadership, Medical leadership, Compliance, Risk Management, Operations leadership, and all clinical team members across the organization. Outside the organization : Develops and maintains strategic relationships with insurance organizations, managed care companies, external review organizations, payer representatives, referral partners, vendors, and consultants, as appropriate. Position Responsibilities Essential Responsibilities Provides executive oversight and strategic direction for all enterprise Utilization Review operations across multiple facilities, service lines, and states. Develops and implements standardized enterprise-wide UR processes, workflows, policies, and documentation standards to improve operational consistency and payer outcomes. Oversees authorization management, concurrent review processes, denial prevention strategies, appeals management, retrospective reviews, and payer escalation processes. Partners with Clinical, Nursing, Admissions, and Revenue Cycle teams to ensure documentation supports medical necessity, level of care determinations, and reimbursement optimization. Develops enterprise KPI dashboards and reporting structures related to denials, overturn rates, authorization timeliness, payer trends, reimbursement performance, length of stay management, and utilization efficiency. Identifies trends, gaps, and opportunities within utilization management processes and leads performance improvement initiatives to enhance operational and financial outcomes. Collaborates with executive leadership regarding payer contracting strategy, authorization challenges, network access issues, and value-based care initiatives. Serves as an organizational expert regarding payer requirements, medical necessity criteria, utilization management regulations, and behavioral health reimbursement practices. Oversees recruitment, onboarding, training, mentorship, performance management, and leadership development for enterprise UR leadership and staff. Conducts regular audits and quality reviews to ensure compliance with regulatory requirements, payer expectations, and organizational standards. Develops escalation pathways and support structures for complex cases, difficult payer interactions, and high-risk authorization issues. Leads enterprise education initiatives related to documentation integrity, medical necessity standards, payer trends, and authorization best practices. Collaborates with Information Technology and EHR leadership to optimize utilization review workflows, reporting capabilities, automation opportunities, and data integrity. Supports organizational growth initiatives, acquisitions, new program development, and expansion strategies through scalable utilization management processes. Participates in executive meetings, operational reviews, and strategic planning initiatives as a key organizational leader. Maintains strict confidentiality of all company, departmental, patient, payer, and healthcare provider information. Reports enterprise risks, payer concerns, and operational barriers to executive leadership with recommendations for resolution and mitigation.