Manager - Utilization Management
About The Position
NHC is seeking an experienced Manager of Utilization Management to lead utilization review operations across its behavioral health hospitals. The role oversees authorizations, concurrent reviews, denial management, payer relationships, and utilization management staff, while supporting timely decisions about appropriate levels of patient care. The manager works with physicians, nursing, case management, and revenue cycle teams; monitors payer requirements, medical necessity criteria, and regulatory compliance; and analyzes performance metrics to improve quality outcomes and financial performance. The position also supports appeals, denial prevention, and operational best practices across facilities.
Requirements
- At least 6 years of clinical experience, preferably in behavioral health.
- At least 3 years of leadership experience.
- Experience in an inpatient psychiatric or behavioral health setting.
- Knowledge of utilization review, payer authorization processes, medical necessity criteria, and denial management.
- Strong communication, analytical, and team leadership skills.
Nice To Haves
- A bachelor's degree in Nursing or a related clinical field is preferred.
- Experience with Medicare, Medicaid, managed care, and commercial insurance processes.
Responsibilities
- Lead and support a team of utilization management professionals.
- Oversee authorization, concurrent review, continued stay review, and denial management activities.
- Partner with physicians, nursing, case management, and revenue cycle teams to support appropriate level-of-care decisions.
- Monitor payer requirements, medical necessity criteria, and regulatory compliance.
- Analyze performance metrics and implement process improvements that support quality outcomes and financial performance.
- Assist with appeals, denial prevention strategies, and operational best practices across facilities.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
