Utilization Review Manager

Welcome to Your Behavioral Health (YBH). Our mission is to guide individuals through the intricate landscape of behavioral health, ensuring that expert support is not only available but also easily accessible. At YBH, we pride ourselves on being a centralized hub teeming with resources designed to aid clients and their families in pinpointing the optimal support tailored to their distinct needs and aspirations for well-being.

Clear Behavioral Health and Neuro Wellness Spa are integral parts of the YBH family, further enriching our offerings and dedication to holistic care.

Dive into our portfolio of brands below. Each represents a unique facet of the comprehensive behavioral health treatment spectrum.

Position Overview:

We are currently seeking a dedicated Utilization Review Manager for Clear Behavioral Health. Bring your expertise to our team and contribute to our mission of transforming the substance abuse and mental health care experience. As a potential Utilization Review Manager, we are seeking an individual with the following:

Qualifications:

Minimum of 3 years in Utilization Review.

Three (3) to five (5) years’ managed care experience in behavioral health/SUD.

Proven ability to create a sense of urgency.

Professional demeanor with a proactive and assertive approach on behalf of our clients.

Familiarity with PHP/IOP/RTC level of care and SUD/MH treatment.

Experience working with commercial health plans.

Proficient in admission and concurrent reviews.

Familiarity with EHR software.

Experience with payer audits.

Communication Skills:

Excellent verbal and written communication skills.

Ability to collaborate and communicate effectively with insurance carriers, call representatives, clients, and personnel in-person, via email, or phone calls.

Responsibilities:

As a Utilization Review Manager, your responsibilities will include:

Managerial Duties:

Provide leadership to the Utilization Review team, fostering a collaborative and high-performance work environment.

Oversee the day-to-day operations of the Utilization Review department, ensuring efficiency and adherence to established protocols.

Conduct regular team meetings to discuss caseloads, challenges, and strategies for improvement.

Mentor and coach team members, promoting professional development and growth.

Collaborate with other managers and departments to streamline processes and enhance overall organizational effectiveness.

Interact and communicate with multidisciplinary teams to ensure continuity and coordination of Members' care.

Other duties as assigned.

Clinical Responsibilities:

Obtaining authorizations for clients across all levels of care.

Utilizing various software such as EMR systems, Microsoft Word, and Excel.

Managing caseloads of teen and adult patients in various in and outpatient facilities.

Collaborating with insurance carriers for authorizations.

Communicating professionally via phone with call representatives, clients, and personnel.

Multitasking between phone calls and online resources.

Annotating phone calls and reviewing with facilities and insurance carriers in various systems.

Utilizing the resources of coworkers and team members, promoting collaboration.

Enhancing attention to detail and organizational skills.

This is not a remote or hybrid position.