Manager - Utilization Management

Nhccare; Murfreesboro (TN); On-site; USD 100,000 - 140,000; Full time

Job summary

National HealthCare Corporation seeks an experienced Manager of Utilization Management to lead utilization review across our behavioral health hospitals. You will oversee authorizations, concurrent reviews, denial management, payer relationships, and a team of utilization management staff to ensure patients receive appropriate levels of care promptly.

The ideal candidate has 6+ years in behavioral health and utilization management, with leadership experience and strong knowledge of

Qualifications

• Bachelor's degree in Nursing or related clinical field.
• 6+ years of clinical experience, preferably in behavioral health.
• 3+ years of leadership experience.

Responsibilities

• Lead and support a team of utilization management professionals.
• Oversee authorization, concurrent review, continued stay review, and denial management activities.
• 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 that support quality outcomes and financial performance.
• Assist with appeals, denial prevention strategies, and operational best practices across facilities.

Skills

Leadership

Communication

Analytical

Team leadership

Education

Bachelor's degree in Nursing or related clinical field

Job description

National HealthCare Corporation
Murfreesboro, TN 37130, USA

Description

Manager of Utilization Management

Behavioral Health Division

We are seeking an experienced Manager of Utilization Management to lead utilization review operations across our behavioral health hospitals. This role is responsible for overseeing authorizations, concurrent reviews, denial management, payer relationships, and utilization management staff while ensuring patients receive the appropriate level of care in a timely manner.

The ideal candidate will have experience in behavioral health, utilization management, and healthcare leadership, with a strong understanding of Medicare, Medicaid, managed care, and commercial insurance processes.

What You'll Do

• Lead and support a team of utilization management professionals.
• Oversee authorization, concurrent review, continued stay review, and denial management activities.
• 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 that support quality outcomes and financial performance.
• Assist with appeals, denial prevention strategies, and operational best practices across facilities.

What We're Looking For

• Bachelor's degree in Nursing or a related clinical field preferred.
• 6+ years of clinical experience, preferably in behavioral health.
• 3+ years of leadership experience.
• Experience in an inpatient psychiatric or behavioral health setting.
• Knowledge of utilization review, payer authorization processes, medical necessity criteria, and denial management.
• Strong communication, analytical, and team leadership skills.

Why Join Us?

This is an opportunity to make a meaningful impact on patient care while helping shape utilization management practices across a growing behavioral health organization. You'll work alongside dedicated clinical and operational leaders who are committed to quality outcomes and continuous improvement.

NHC is an Equal Opportunity Employer.

Training - Other

Expert

Equal Opportunity Employer
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