Senior Manager, Behavioral Health Utilization Management

This is a fully remote position, open to applicants in Florida.

📋 Description

• Supervise behavioral health utilization review clinicians to guarantee appropriate care for members.

• Ensure adherence to relevant guidelines, regulations, contractual obligations, accreditation standards, and industry best practices.

• Evaluate and analyze utilization management activities, utilization rates, operations, expenses, and projected data.

• Monitor goals, objectives, and performance metrics for the behavioral health utilization management team.

• Manage and assess utilization management and financial reports, identify trends, and suggest enhancements to senior leadership.

• Identify and communicate process improvements to the senior leadership team in behavioral health.

• Develop and enforce utilization management policies, procedures, and guidelines.

• Educate and equip the utilization management team with necessary resources.

• Oversee training and support strategies for onboarding, hiring, and training team members.

• Provide career development feedback to Supervisors and lead talent management initiatives.

• Attend company meetings in the absence of people leaders.

• Handle escalated calls and issues that require further investigation or special attention.

• Drive change and manage cross-functional projects within tight deadlines.

• Perform additional duties as assigned and adhere to all policies and standards.

⛳️ Requirements

• Active clinical license: LCSW, LMHC, LPC, LMFT, LMHP, or RN.

• Graduate from an Accredited School of Nursing or possess a Bachelor's degree.

• More than 6 years of relevant experience, including previous management roles.

• Preferred 3+ years of management experience.

• License to practice independently and/or state-required licensure.

• Strong understanding of utilization management principles is preferred.

• Advanced knowledge of medical necessity criteria for a wide range of behavioral health services is preferred.

• Capacity to lead and manage teams in a matrixed/cross-functional environment with tight deadlines.

• Proficiency in presenting information and addressing inquiries from peers, leaders, and both internal and external customers.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be included in the overall compensation package.

• Equal opportunity employer dedicated to diversity.