Utilization Review Manager

This is a fully remote position, open to applicants in Kansas, +1 more state.

📋 Description

• Act as a liaison among treatment teams, funding sources, and external collaborators.

• Acquire and evaluate clinical and medical service authorizations for clients at Great Circle facilities.

• Interact with funding source departments to obtain initial and ongoing inpatient stay authorizations.

• Secure transitional care authorizations.

• Provide essential discharge information to external collaborators.

• Work collaboratively with admissions and statewide clinical teams.

• Analyze data to reinforce treatment recommendations.

• Approve clinical documentation completed by program personnel.

• Ensure compliance and support for authorized services.

• Report to the Utilization Review Manager Supervisor.

⛳️ Requirements

• Master’s Degree in Social Work, Counseling, Psychology, or a related discipline; OR an Associate degree in Nursing.

• Registered Nurse (RN) license is strongly preferred; LPN licensure will be considered with suitable experience.

• Experience with commercial and managed Medicaid behavioral health plans.

• Experience in securing continued stay authorizations for mental health services.

• Strong working knowledge of current CPT coding relevant to behavioral health services.

• Familiarity with DSM diagnostic classification.

• Experience with accounting or claims for billing resolution.

• Valid Class E Driver’s License.

• Experience in a residential setting is preferred.

• Experience working with children and families in a trauma-informed environment is preferred.

• In-depth understanding of clinical theory, therapy, and behavioral health systems.

• Ability to convey complex psychiatric and medical information effectively.

• Knowledge of community wrap-around services.

• Analytical skills to manage administrative details and prepare nonrecurring reports.

• Excellent time management and organizational abilities.

• Capacity to work effectively with individuals and families from diverse cultural backgrounds.

• Proficiency in PC-based software, including Excel, Word, and Outlook.

• Exceptional oral and written communication skills.

• Ability to coordinate effectively across remote teams.

🏝️ Benefits

• Paid Time Off.

• Paid Parental Leave.

• Health, Dental, Vision & Life Insurance.

• 403(b) with Company Match.

• Tuition Reimbursement.

• Professional Licensure and Certification Reimbursement.

• Employee Assistance Program.

• Wellness Benefits, including health screenings and mental health support.

• Wellbeing, DEI+B, and Talent Development programs.

• Work-life balance.