Utilization Review Manager

At Discovery Behavioral Health, we know the best way to predict the future of healthcare is to create it.  As a member of our growing team, you will have a voice in the creation of life-changing programs and treatment centers nationwide.  Working collaboratively with the best and the brightest in our industry, you will be part of an innovative team of professionals committed to generating positive and remarkable outcomes for the clients we serve.

If you are looking for an organization that thrives on growth, celebrates diversity of thought, and rewards passionate execution, you’ve come to the right place.  Because we put clients first, it is our honor to support and reward those who serve them.

Compensation Range: $61-74k per year.

Compensation will be dependent upon geographic region, education, and experience.

Our Offer to You!

We are dedicated to empowering our employees with their professional and personal development by providing:   

• 401(k) 
• Healthcare benefits  
• Vacation and sick days
• Employee referral program 
• Employee discounts to various stores, amusement parks, events, etc. 
• Continuing education (CE) programs and training 
• Weekly training opportunities  
• Advancement opportunities within the organization 

The Utilization Review Case Manager requires effective communication and coordination with the Director of Utilization Review, insurance companies, admissions coordinators, and treatment team to obtain the maximum benefits for our clients. You will have oversight of Discovery Behavioral Health Programs. You will make sure you can submit accurate utilization reviews in an extremely tight timeline. Good verbal and written communication skills is required. Record keeping must be accurate and thorough. You must be able to discern medical necessity to for a busy and growing drug, alcohol, and mental health facility. Flexibility with your schedule, so that you can meet critical deadlines as established, is essential.

Responsibilities

• Conduct pre-authorizations for admitting clients that require it based on payer, geography or low acuity.
• Provide clinical guidance and support to the Admissions Coordinators as it relates to medical necessity criteria and appropriate level of care.
• Conduct weekly UR office hours/consultation groups.
• Track and closely monitor authorization status and length of stay and provide coaching/support and direction in order to increase funded length of stay
• Create, implement and enforce UR policies and procedures.
• Create and maintain UR manual including payer specific criteria guidelines and disseminate to all clinical staff.

This is a full-time position.

• Required Bachelors Degree, Master’s Degree preferred
• Licensed LMFT, LCSW, LPCC, or RN
• Prior experience in doing utilization review for mental health facilities
• Strong knowledge of medical necessity criteria
• Knowledge of DSM-V Codes
• Previous employment working with Mental Health Disorder’s preferred.
• Knowledge of RTC, PHP, and IOP Mental Health programs

Not sure if you meet all the qualifications? Apply anyway! To provide truly innovative care, we need to have a diverse team around us. That’s why Discovery Behavioral Health is committed to creating an inclusive environment. If you find yourself meeting some but not all the above, we’d be happy to consider your application.

We are proud to be an EEO employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, or national origin.

For more information about our company benefits, please visit us at discoverybehavioralhealth.com/careers/

Discovery Behavioral Health seeks to build a diverse staff that is reflective of the patients we serve and the communities where we work. DBH encourages multiple perspectives, experiences, and strives to hire and retain a diverse workforce.