Behavioral Health Utilization Review Manager - Optimize

Raleigh Oaks Behavioral Health; Garner (NC); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

Raleigh Oaks Behavioral Health in Garner, North Carolina, seeks an experienced Utilization Review Manager to lead the UR department. You will oversee admissions review, continued stays, and discharge planning, ensuring compliance with approved criteria and payer requirements.

You will supervise staff, coordinate with Admissions and Medical staff, and manage denials, appeals and chart reviews to optimize outcomes and reimbursement. This role is based on site in Garner, NC.

Qualifications

• Graduation from an accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field.
• Master's Degree in same field preferred.
• Current licensure as an LPN or RN or current clinical professional license or certification, as required, within the state where the facility provides services.
• CPR and de-escalation certification required.

Responsibilities

• Assigns patients to Utilization Review staff and supervises to ensure timely insurance verifications and regulatory compliance.
• Leads a team through hiring, orientation, performance assessment, scheduling, coaching and overall department operation.
• Reviews admissions and determines appropriateness of care; collaborates with admissions and UR committee as needed.
• Appeals denials and coordinates correspondence to ensure accurate information and timely actions.
• Analyzes patient records to confirm admission criteria, treatment plans and length of stay per hospital and payer policies.
• Oversees concurrent and retrospective reviews and supports quality assurance activities.

Job description

Raleigh Oaks Behavioral Health in Garner, North Carolina, seeks an experienced Utilization Review Manager to lead the UR department. You will oversee admissions review, continued stays, and discharge planning, ensuring compliance with approved criteria and payer requirements.

You will supervise staff, coordinate with Admissions and Medical staff, and manage denials, appeals and chart reviews to optimize outcomes and reimbursement. This role is based on site in Garner, NC.