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Director of Utilization Management

Director of Utilization Management

Job Locations: US-FL-Miami


Position Type


Monte Nido & Affiliates

Remote or Miami, FL

Monte Nido & Affiliates has been delivering treatment for eating disorders for over two decades.Our programs offer a model of treatment that blends medically sophisticated care with a personalized treatment approach. Our work is grounded in evidence-based strategies for adults and adolescents suffering from eating disorders. We work from a multi-disciplinary treatment team approach while integrating state-of-the-art medical, psychiatric, nutritional, and clinical strategies to provide comprehensive care within an intimate home setting.

We are looking for a Director of Utilization Management to oversee the Utilization Management/Review team and function. This role with report to the Chief Medical Officer.

Responsibilities Include:

The Director of Utilization Management (UM) will work in partnership with the Chief Medical Officer to ensure the utilization review activities at Monte Nido & Affiliates’ facilities are completed accurately, timely and in compliance with regulations.

This includes the precertification and recertification, peer to peer process, and appeals. The UM Director will manage and analyze the status of authorizations, clinical documentation, current denial rates and appeals and report outcomes to the Chief Medical Officer. The UM Director will collaborate with the managed care contract team, revenue cycle, legal and compliance, and oversee and scale the UR team.

  • Will develop and maintain appropriate facility/corporate reports to track relevant indicators related to UM.
  • Assists with training, writing, tracking, and following up on appeals.
  • Ensures peer reviews/doctor-to-doctors reviews are occurring as needed and/or as scheduled.
  • Works with the clinical staff to ensure documentation requirements are met.
  • Works to ensure appeals are completed thoroughly and in a timely manner.
  • Interfaces with managed care contract team, revenue cycle, legal and compliance and managed care organizations, external reviewers, and other payers as needed to resolve denials.
  • Works with facilities to ensure accurate reporting of denials and outcomes on a regular basis.
  • Is proficient in data gathering, Excel spreadsheets, reporting and data analysis.


Education: Master’s degree and current clinical license strongly preferred

Experience: Previous utilization management experience in a behavioral healthcare facility preferred, knowledge of Joint Commission compliance strongly preferred

License: Current unencumbered clinical license and valid driver’s license