Behavioral Health Utilization Review Manager

Summit BHC; Garner, Northern (NC, KY); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Competitive salary

Comprehensive benefits

EOE

Job summary

Raleigh Oaks Behavioral Health in North Carolina seeks an experienced Utilization Management Manager to lead the UM department, oversee admissions review, continued stays, and discharge planning, and optimize payer approvals.

The role requires RN or LPN licensure or clinical license, a bachelor’s degree in nursing or related field, 4+ years of UM experience, 2+ years of supervisory experience, and CPR/de-escalation certification. A Master’s degree is preferred.

Qualifications

• Requires RN/LPN licensure or clinical professional license within the state.
• Bachelor's in nursing or related health field required; Master's preferred.
• 4+ years clinical experience in utilization management; 2+ years supervisory experience.

Responsibilities

• Lead and supervise UM staff to ensure timely insurance verifications and regulatory compliance.
• Review admissions, continued stays, and discharge planning against approved criteria.
• Coordinate with Admissions and business office to resolve payment and approvals.
• Oversee concurrent and retrospective reviews and quality assurance activities.
• Act as liaison between Medicaid reviewers and UM staff.

Skills

Communication

Multidisciplinary teamwork

Regulatory compliance

Problem solving

Education

Bachelor's in Nursing

Bachelor's in Social Work/Behavioral Health

Master's degree preferred

Job description

Raleigh Oaks Behavioral Health in North Carolina seeks an experienced Utilization Management Manager to lead the UM department, oversee admissions review, continued stays, and discharge planning, and optimize payer approvals.

The role requires RN or LPN licensure or clinical license, a bachelor’s degree in nursing or related field, 4+ years of UM experience, 2+ years of supervisory experience, and CPR/de-escalation certification. A Master’s degree is preferred.