Behavioral Health Utilization Review Manager

Progressions; Philadelphia (Philadelphia County); On-site; USD 70,000 - 100,000; Full time

Job summary

Malvern Health is seeking a full-time Utilization Review Manager in Philadelphia to lead the Utilization Review team and collaborate with the Clinical department to obtain payment certifications for stays and services.

The role requires a graduate degree and prior utilization review experience, plus strong leadership, documentation, and communication skills to ensure medical necessity is properly demonstrated and all policies are followed.

Qualifications

• Master's degree or graduate of an accredited nursing program with PA licensure.
• Prior utilization review experience preferred.
• Strong organizational and communication skills.

Responsibilities

• Maintain accurate work logs of all reviews with emphasis on documentation.
• Coordinate between clinical and UM to ensure correct level of care.
• Perform concurrent continued stay reviews using ASAM criteria.
• Communicate with insurance payers to obtain certifications and handle appeals.
• Oversee treatment engagement specialists to ensure timely authorizations.
• Identify patterns of mis-utilization and educate staff.

Skills

Leadership

Communication

Team coordination

Education

Master's degree

Nursing licensure in PA

Tools

Microsoft Office

Billing systems

Job description

Malvern Health is seeking a full-time Utilization Review Manager in Philadelphia to lead the Utilization Review team and collaborate with the Clinical department to obtain payment certifications for stays and services.

The role requires a graduate degree and prior utilization review experience, plus strong leadership, documentation, and communication skills to ensure medical necessity is properly demonstrated and all policies are followed.