Utilization Review Manager
About The Position
KVC Missouri is seeking a dedicated and detail-oriented Utilization Review Manager (URM) to serve as a vital link between our treatment teams, funding sources, and external partners. In this role, you will ensure that all clinical and medical services for our clients are reviewed and authorized, supporting our mission to provide high-quality behavioral healthcare to children and families. The Utilization Review Manager (URM) is responsible for obtaining and reviewing clinical and medical service authorizations for clients at Great Circle locations. You will communicate effectively with funding source departments to secure initial and continued inpatient stay authorizations, obtain transitional care authorizations, and provide necessary discharge information. Working closely with admissions and clinical teams statewide, you will analyze data to support treatment recommendations and approve clinical documentation completed by program staff.
Requirements
- Master’s Degree in Social Work, Counseling, Psychology, or a related field; OR an Associate degree in Nursing.
- Registered Nurse (RN license is highly preferred); LPN licensure will be considered with appropriate experience for this role.
- Working with commercial and managed Medicaid behavioral health plans.
- Securing continued stay authorizations for mental health services.
- Solid working knowledge of current CPT coding for behavioral health services and familiarity with DSM diagnostic classification.
- Experience with accounting or claims for billing resolution.
- Valid Class E Driver’s License.
Nice To Haves
- Experience in a residential setting.
- Experience working with children and families in a trauma-informed environment.
Responsibilities
- Liaise between KVC treatment teams and external funding partners to manage clinical service reviews.
- Secure initial and continued inpatient stay authorizations through effective communication with funding source departments.
- Work collaboratively with admissions and statewide clinical teams to support treatment recommendations through data analysis.
- Approve clinical documentation to ensure compliance and support for authorized services.
- Obtain transitional care authorizations and manage the flow of discharge information to partners.
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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
