Manager - Utilization Management

National HealthCare Corporation (NHC); Murfreesboro (TN); On-site; USD 110,000 - 140,000; Full time

Job summary

National HealthCare Corporation (NHC) in Murfreesboro, TN seeks an experienced Manager of Utilization Management to lead utilization review operations across behavioral health hospitals. You will oversee authorizations, concurrent reviews, denial management, payer relations, and UM staff to ensure patients receive appropriate care in a timely manner.

The ideal candidate has expertise in behavioral health, utilization management, and healthcare leadership, with strong Medicare/Medicaid, managed

Qualifications

• Bachelor's degree in Nursing or related clinical field.
• 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.

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

Utilization management

Payer authorization

Communication

Data analysis

Education

Bachelor's degree in Nursing or related field

Job description

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.