Utilization Review Manager

General Statement of Duties: The Utilization Review Manager is responsible for coordinating, managing, and documenting medical necessity and authorization processes for behavioral health services reimbursed by commercial payers. This role supports residential treatment, partial hospitalization (PHP), and intensive outpatient (IOP) levels of care. In addition, the UR Manager collaborates with community mental health providers to support billing and compliance for specialized service contracts. The position serves as a critical liaison between clinical teams, payers, and external provider partners to ensure timely authorizations, accurate documentation, and optimized reimbursement while maintaining compliance with regulatory and contractual requirements.

• Bachelor’s degree in healthcare, behavioral health, social work, nursing, or a related field, or equivalent experience.
• Experience in utilization review, care coordination, or revenue cycle functions within a behavioral health setting.
• Working knowledge of commercial insurance authorization processes for residential, PHP, and IOP services.
• Strong written and verbal communication skills, including clinical documentation review.
• Ability to manage multiple cases, deadlines, and payer requirements simultaneously.

Preferred

• Licensed or license-eligible clinical background (e.g., RN, LCSW, LMFT, LPC).
• Experience working with community mental health providers and contracted services.
• Familiarity with medical necessity criteria (e.g., ASAM, LOCUS, InterQual, or similar).
• Experience with electronic health records and utilization management software.