Access & Utilization Manager - Social Services

Four Oaks Family & Children Services•Cedar Rapids, IA

1d•Onsite

About The Position

We’re looking for a detail-oriented Access & Utilization Manager to ensure members receive timely, appropriate care funded through Medicaid MCOs and private insurance. This role partners closely with clinical teams and payers to support authorizations, compliance, and quality outcomes.

Requirements

Associate's degree and 2 years of related experience OR a Bachelor's degree and 1 year of related experience
Experience with billing and handling claims (submitting, tracking, and following up)
Comfortable working through claim issues and making sure things are accurate and completed on time
Experience in utilization management, healthcare authorizations, or behavioral health
Strong knowledge of Medicaid, MCOs, and insurance processes
Excellent organizational, analytical, and communication skills

Responsibilities

Review clinical information for intake, reauthorization, and discharge planning
Verify Medicaid eligibility and maintain accurate funding records
Secure prior authorizations (MCOs, private insurance, private pay) and identify co-pays
Enter and manage funding data in MyEvolv; escalate denials promptly
Support staff in determining medical necessity, level of care, and length of stay
Monitor utilization trends (e.g., readmissions, high-cost cases) and support improvement efforts
Track Single Case Agreements for PMIC clients and B3 for QRTP
Escalate complex/high-risk cases and assist with resolution
Ensure compliance with documentation, audits, and contractual requirements
Collaborate with internal teams and external partners to improve care coordination
Set up and process Client Participation Fee with guardians