Behavioral Health Utilization Manager

Raleigh Oaks Behavioral Health

Garner (NC)

On-site

USD 90,000 - 120,000

Full time

5 days ago

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Job summary

Raleigh Oaks Behavioral Health is seeking an Utilization Management Manager to lead and optimize the UM department, overseeing admissions, continued stays, discharge planning, and denials management. The role requires clinical background (RN or related health field) and supervisory experience, with collaboration across admissions, medical staff, and the business office.

Applicants should have strong communication skills, experience with insurance verifications, and familiarity with regulatory

Qualifications

Minimum of four years' clinical experience with population served by facility.
Two+ years’ supervisory experience in clinical/utilization management.

Responsibilities

Lead and manage Utilization Management department operations.
Oversee admission, continued stay and discharge planning reviews.
Coordinate with Admissions and Business Office to ensure accurate patient information and resolve coverage or payment issues.
Oversee insurance pre-certification, appeals and denial management.
Ensure staff conduct insurance verifications on time and comply with regulatory standards.
Communicate with multidisciplinary teams using clear technical language.
Act as liaison between Medicaid reviewers and required paperwork for UR processes.