Director of Utilization Review

Nashville, TN

 

Why Charlie Health?

Millions of people across the country are navigating mental health conditions, substance use disorders, and eating disorders, but too often, they’re met with barriers to care. From limited local options and long wait times to treatment that lacks personalization, behavioral healthcare can leave people feeling unseen and unsupported.

Charlie Health exists to change that. Our mission is to connect the world to life-saving behavioral health treatment. We deliver personalized, virtual care rooted in connection—between clients and clinicians, care teams, loved ones, and the communities that support them. By focusing on people with complex needs, we’re expanding access to meaningful care and driving better outcomes from the comfort of home.

As a rapidly growing organization, we're reaching more communities every day and building a team that’s redefining what behavioral health treatment can look like. If you're ready to use your skills to drive lasting change and help more people access the care they deserve, we’d love to meet you.

About the Role

The Director of Utilization Review (UR) is responsible for leading, planning, and managing all activities related to utilization management to ensure the delivery of cost-effective, quality healthcare services to Charlie Health clients. This position oversees the day-to-day operations of the Utilization Review department, ensuring compliance with regulatory requirements, payer guidelines, and internal policies. The Director collaborates with clinicians, revenue cycle management, insurance providers, and leadership to ensure appropriate use of healthcare resources.
 
We’re a team of passionate, forward-thinking professionals eager to take on the challenge of the mental health crisis and play a formative role in providing life-saving solutions. If you’re inspired by our mission and energized by the opportunity to increase access to mental healthcare and impact millions of lives in a profound way, apply today.

Responsibilities

  • Provide strategic and operational leadership for the UR department.
  • Develop and monitor departmental KPIs and quality metrics.
  • Develop and implement policies, procedures, and workflows that ensure timely and accurate utilization reviews.
  • Ensure compliance with federal, state, and accreditation standards.
  • Monitor and evaluate UR activities to identify trends, performance gaps, and opportunities for improvement.
  • Supervise and mentor UR staff, including managers, nurses, and support personnel.
  • Serve as a liaison with clinicians, payers, and internal departments to facilitate effective care coordination.
  • Oversee the clinical review process for medical necessity, level of care determinations, and continued stay reviews.
  • Ensure denial management and appeal processes are handled appropriately and efficiently.
  • Collaborate with IT to support UR software optimization and reporting tools.
  • Participate in budget planning and manage departmental resources effectively.

Requirements

  • Bachelor's degree preferred.
  • 2+ years’ experience working with young adults and adolescents required. Experience in the mental health field is preferred.
  • At least 5 years in a leadership or management role.
  • Strong knowledge of medical necessity criteria (e.g., InterQual, MCG).
  • Proficiency in EMR and UR management systems.
  • Excellent communication, negotiation, and leadership skills.
  • Strong analytical and problem-solving capabilities.
  • Ability to manage cross-functional teams and work in a fast-paced environment.
  • Work authorized in the United States and native or bilingual English proficiency
  • Familiarity with and willingness to use cloud-based communication software—Google Suite, Slack, Zoom, Dropbox, Salesforce–in addition to EMR and survey software daily.
  • This position is not available for candidates with residency in CA, NY and CO currently.
  • Please note that members of this team who live within 45 minutes of a Charlie Health office are expected to adhere to a hybrid work schedule.

Benefits

Charlie Health is pleased to offer comprehensive benefits to all full-time, exempt employees. Read more about our benefits here. #LI-Remote

The total target base compensation for this role will be between $97,000 and $125,000 per year at the commencement of employment. In addition to base compensation, this role also offers a performance bonus. The expected total cash compensation range, including potential bonus, will be between $106,000 and $138,000 per year. Please note, pay will be determined on an individualized basis and will be impacted by location, experience, expertise, internal pay equity, and other relevant business considerations. Further, cash compensation is only part of the total compensation package, which, depending on the position, may include stock options and other Charlie Health-sponsored benefits.

 

Our Values

  • Connection: Care deeply & inspire hope.
  • Congruence: Stay curious & heed the evidence.
  • Commitment: Act with urgency & don’t give up.

Please do not call our public clinical admissions line in regard to this or any other job posting.

Please be cautious of potential recruitment fraud. If you are interested in exploring opportunities at Charlie Health, please go directly to our Careers Page: https://www.charliehealth.com/careers/current-openings. Charlie Health will never ask you to pay a fee or download software as part of the interview process with our company. In addition, Charlie Health will not ask for your personal banking information until you have signed an offer of employment and completed onboarding paperwork that is provided by our People Operations team. All communications with Charlie Health Talent and People Operations professionals will only be sent from @charliehealth.com email addresses. Legitimate emails will never originate from gmail.com, yahoo.com, or other commercial email services.

Recruiting agencies, please do not submit unsolicited referrals for this or any open role. We have a roster of agencies with whom we partner, and we will not pay any fee associated with unsolicited referrals.

At Charlie Health, we value being an Equal Opportunity Employer. We strive to cultivate an environment where individuals can be their authentic selves. Being an Equal Opportunity Employer means every member of our team feels as though they are supported and belong. We value diverse perspectives to help us provide essential mental health and substance use disorder treatments to all young people.

Charlie Health applicants are assessed solely on their qualifications for the role, without regard to disability or need for accommodation.

By submitting your application, you agree to receive SMS messages from Charlie Health regarding your application. Message and data rates may apply. Message frequency varies. You can reply STOP to opt out at any time. For help, reply HELP.

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