Behavioral Health Utilization Management Leader

AdamsPlace; Murfreesboro (TN); On-site; USD 110,000 - 140,000; Full time

Job summary

AdamsPlace is seeking an experienced Manager of Utilization Management within its Behavioral Health Division in Murfreesboro, TN. The role leads utilization review operations across behavioral health hospitals, overseeing authorizations, reviews, denial management, payer relationships, and staff to ensure appropriate care in a timely manner.

The ideal candidate will bring behavioral health and utilization management expertise, with knowledge of Medicare, Medicaid, managed care, and commercial

Qualifications

• RN or equivalent clinical degree required.
• 6+ years of clinical experience, preferred in behavioral health.
• 3+ years in a leadership role.
• Experience in inpatient psychiatric/behavioral health settings.

Responsibilities

• Lead and support a team of utilization management professionals.
• Oversee authorization, concurrent review, continued stay review, and denial management.
• 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.
• Assist with appeals and denial prevention strategies.

Skills

Leadership

Healthcare administration

Analytical skills

Communication

Team collaboration

Education

Bachelor's degree in Nursing or related field

Job description

AdamsPlace is seeking an experienced Manager of Utilization Management within its Behavioral Health Division in Murfreesboro, TN. The role leads utilization review operations across behavioral health hospitals, overseeing authorizations, reviews, denial management, payer relationships, and staff to ensure appropriate care in a timely manner.

The ideal candidate will bring behavioral health and utilization management expertise, with knowledge of Medicare, Medicaid, managed care, and commercial