Utilization Review Manager

NRT |Foundry Treatment Center•Broomfield, CO

11h•$60,000 - $72,000•Remote

About The Position

The Utilization Review Manager is responsible for overseeing utilization review activities to ensure medical necessity, regulatory compliance, and timely authorization of behavioral health services. This role manages the utilization review team, collaborates with clinical and administrative leadership, and supports optimal patient care while maximizing reimbursement and minimizing denials.

Requirements

Bachelor’s degree required.
Active clinical license required (RN, LCSW, LMFT, LPC, or equivalent); DORA registered.
Minimum of 3 years of utilization review or care management experience in behavioral health.
Minimum of 1 year of supervisory or management experience.
Strong knowledge of medical necessity criteria and behavioral health levels of care.
Familiarity with major commercial and government payors.
Leadership and team management.
Attention to detail and strong documentation review skills
Excellent organizational, analytical, and communication skills.
Ability to manage multiple priorities in a fast-paced environment.
Professional communication with payors and clinical staff.
Data-driven decision making skills.
Proficient with EHR systems and utilization management tools.
Proficient with Google Workspace or related software.

Responsibilities

Manage and supervise the Utilization Review team, including hiring, training, scheduling, and performance management.
Oversee authorization and reauthorization processes for behavioral health services across payors.
Ensure compliance with federal, state, and payor-specific regulations and guidelines.
Review clinical documentation to confirm medical necessity and completeness.
Serve as the primary escalation point for complex cases, denials, and peer-to-peer reviews.
Track and analyze utilization metrics, authorization turnaround times, and denial trends.
Collaborate with clinical leadership to improve documentation practices and treatment planning.
Develop and maintain utilization review policies, procedures, and workflows.
Support audits, accreditation reviews, and quality improvement initiatives.
Communicate effectively with insurance companies, clinicians, and internal stakeholders.
Other duties as assigned.

Benefits

Health and Wellness Medical, dental and vision insurance
Supplemental accident and hospital indemnity coverage
Voluntary Term Life insurance
Employee Assistance Program
Monthly wellness reimbursement
Financial Competitive salary
Employee recognition and rewards programs
Employee referral incentive program
Employer-sponsored 401(k) plan
Work/Life Perks Professional growth and development
Continuing education reimbursement
Unlimited paid time off (exempt employees) + sick days
Paid time off policy (non-exempt employees) + sick days
Paid holidays (exempt) or ability to earn 1.5x base hourly rate (non-exempt) Full-time employees