Manager - Utilization Management

NHC Careers • Murfreesboro, TN

17h

About The Position

The Manager of Utilization Management leads utilization review operations across behavioral health hospitals. The role oversees authorizations, concurrent and continued-stay reviews, denial management, payer relationships, and utilization management staff, while supporting timely and appropriate levels of patient care. The manager works with clinical and operational leaders to support quality outcomes and financial performance and to shape utilization management practices across the organization.

Requirements

• Six or more years of clinical experience, preferably in behavioral health.
• Three or more 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

• Bachelor's degree in Nursing or a related clinical field preferred.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager