Regional Director – Utilization Management

Bradford Health Services

Regional Director of Utilization Management providing strategic oversight and operational leadership for Utilization Management services. Ensuring timely access to care and optimizing reimbursement across assigned facilities

Posted 7/21/2026full-timeBirmingham • Alabama • 🇺🇸 United StatesLead💰 $115,000 - $130,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive experience in Utilization Management, including oversight of authorization processes, clinical documentation, and performance metrics. Proven ability to lead multi-site teams and collaborate with clinical and payer representatives to enhance patient care and operational efficiency.

Highest-signal resume keywords

Utilization Management LeadershipConcurrent Review ManagementMedical Necessity ExpertisePayer Authorization KnowledgeBehavioral Health Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ManagementConcurrent ReviewMedical NecessityPayer AuthorizationsAppeals ManagementQuality AuditsPerformance Metrics MonitoringCorrective Action PlanningClinical Documentation ImprovementRevenue Cycle Management

Soft Skills

Collaborative LeadershipRelationship BuildingAccountabilityProblem SolvingCommunication

Certifications & Qualifications

Bachelor's Degree in NursingBachelor's Degree in Healthcare AdministrationBachelor's Degree in Health Information ManagementBachelor's Degree in Social Work

Industry Keywords

Commercial AuthorizationMedicare AuthorizationMedicaid AuthorizationVA AuthorizationSubstance Use Disorder Treatment

About the role

Key responsibilities & impact

Provide regional operational leadership for Utilization Management across assigned facilities.
Directly supervise Utilization Review Managers.
Establish accountability for quality, productivity, timeliness, and financial performance.
Ensure consistent implementation of enterprise Utilization Management standards.
Monitor staffing levels and workload distribution to optimize productivity and patient outcomes.
Oversee initial authorization and concurrent review activities.
Ensure timely submission of clinical documentation to payers.
Monitor authorization status to minimize interruptions in patient care.
Collaborate with clinical teams to maximize medically appropriate authorized days.
Escalate complex authorization issues as appropriate.
Promote accurate and complete clinical documentation supporting medical necessity.
Partner with physicians and clinical leadership to improve documentation quality.
Monitor trends related to authorization denials and documentation deficiencies.
Collaborate with clinical teams to improve documentation practices.
Oversee appeal strategy for medical necessity denials.
Support peer-to-peer review processes.
Identify payer trends and develop regional action plans.
Build collaborative relationships with payer representatives.
Participate in payer meetings and operational reviews.
Monitor regional performance metrics including: Authorization approval rate Initial authorization timeliness Continued stay (concurrent review) approval rate Medical necessity denial rate Appeal overturn rate Average approved Length of Stay Revenue at Risk Productivity Quality audit scores Develop corrective action plans when performance targets are not achieved.

Requirements

What you’ll need

Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, Social Work, or related healthcare field required.
Minimum seven (7) years of progressive Utilization Management, Case Management, Revenue Cycle, or Behavioral Health leadership experience.
Minimum three (3) years leading multi-site teams.
Demonstrated Behavioral Health and/or substance use disorder (SUD) treatment experience required.
Experience managing concurrent review, medical necessity, payer authorizations, appeals, and utilization management operations.
Strong knowledge of commercial, Medicare, Medicaid, and VA authorization requirements.

Benefits

Comp & perks

Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits.
Expanded Coverage – Options for domestic partners and a wider network of in-network providers.
Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching.
Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more.
Student Loan Repayment – Available for nurses and therapists.
Retirement Benefits – 401(k) plan through Voya to help employees plan for the future.
Generous PTO – A robust paid time off policy to support work-life balance.
Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.