Utilization Management Manager
Utilization Review Manager Lead, Support & Shape Quality Care Join a mission-driven team where your expertise in clinical documentation, insurance processes, and patient advocacy directly impacts client care and successful outcomes. As the Utilization Review (UR) Manager, you will lead a highly engaged team, streamline workflows, and ensure regulatory complianceall while supporting clients' access to necessary treatment.
Roles and Responsibilities :
- High School Diploma or equivalent required
- Preferred : Graduation from an accredited Nursing program (LPN / RN) or Bachelor's degree in social work, behavioral health, mental health, or a related field
- 2+ years of clinical experience in a substance abuse setting REQUIRED
- 2+ years of utilization management experience in medical / psychiatric care REQUIRED
- Strong knowledge of admission, concurrent, continued-stay, and retrospective review criteria
Skills & Competencies :
Exceptional communication skills across multidisciplinary teamsAbility to provide clear, concise, clinically accurate information using technical languageStrong critical thinking, problem solving, and attention to detailAbility to navigate managed care processes with confidenceSupervisory Requirements
Minimum 1 year of supervisory experience in a clinical or utilization review settingLead & Support a High-Performing UR Team
Assign caseloads to UR staff and oversee timely, accurate insurance verificationsHire, train, motivate, and coach team members to meet department goalsConduct performance assessments, orientation, scheduling, and ongoing developmentEnsure Accurate Assessments & Compliance
Review medical records to evaluate appropriate level of care at admission and throughout treatmentEnsure staff competencies meet internal and external regulatory standardsMonitor charting accuracy and ensure deficiencies are resolved quicklyIdentify cases for Medical Director review based on complex clinical or documentation factorsCollaborate Across Departments
Partner with Admissions to ensure complete and accurate pre-certificationApprove admissions or escalate cases to the UR Committee when criteria are not metCommunicate coverage issues with clinical, nursing, medical, and administrative teamsCoordinate with the business office to prevent or resolve payment concernsManage Insurance Processes & Appeals
Resolve discrepancies in benefit information and insurance verificationAppeal insurance denials with accurate, complete documentation and timely submissionsConduct concurrent and retrospective reviews for all clientsServe as the liaison for Medicaid reviewers and support staff submitting required documentationDrive Quality & Adherence to Standards
Analyze client records to ensure appropriateness of admission, treatment plans, and length of stayApply insurance, government, and accrediting standards to uphold facility complianceAssist in quality assurance activities and review committee planningWhy Wooded Glen Recovery Center? Wooded Glen Recovery Center offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Wooded Glen Recovery Center is an EOE. Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.