Manager Utilization Review

St. Louis Children’s and KVC Health Systems; St. Louis (MO); On-site; USD 75,000 - 110,000; Full time

Job summary

Camber seeks an experienced Utilization Review Manager in St. Louis to lead a department responsible for managing patient stays with health plan interfaces. You will supervise UR Specialists, coordinate with physicians and treatment teams, and ensure policy compliance with Camber values.

The role emphasizes leadership, data accuracy, confidentiality, and collaboration with families and community partners. Strong English, a BS in a human service field, and UR experience are required; the

Qualifications

• Bachelor’s degree in a human service field such as social work, education, sociology, psychology, counseling, human relations, or criminal justice.
• A minimum of two years of experience in Utilization Review and at least one year of experience in a leadership role.
• Valid driver’s license and auto insurance.
• Intermediate proficiency with Microsoft Office, specifically Word, Excel, and Outlook.
• Strong command of the English language, both verbal and written, to conduct official administrative and operational business.

Responsibilities

• Direct supervision of Utilization Review Specialists to ensure task completion and policy compliance.
• Managing telephonic interfaces with health plans to provide clinical information developed by treatment teams.
• Leading departmental operations including oversight of responsibilities, performance evaluations, and approval of workflow.
• Compiling and managing utilization review data with high attention to detail and accuracy.
• Communicating effectively with diverse constituencies, including families, community partners, and service agencies.
• Maintaining the highest standards of confidentiality and adhering to regulatory procedures.
• Participating actively in treatment team meetings and staff conferences to ensure continuity of care.

Skills

Utilization Review

Leadership

Microsoft Office

Education

Bachelor's degree in human services

Bachelor’s degree in social work (preferred licensure)

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Full Time MO - St Louis, St. Louis, MO, US

Location: St. Louis, MO

Elevate your career with an organization that truly cares. Camber is proud to announce a Work Wellbeing Score of 83, reflecting our deep commitment to a supportive, inclusive, and healthy workplace culture. We are seeking a dedicated Utilization Review Manager to lead our team in St. Louis, driving excellence in patient care coordination and clinical advocacy.

The Role

The Utilization Review Manager provides engaging and inclusive leadership to a department responsible for managing all aspects of patient stays relative to health plan interfaces. Operating at the fast pace of short-term hospitalization, you will partner with physicians, nurses, and therapists to ensure timely, accurate assessments and appropriate referrals. You will supervise Utilization Review Specialists, ensuring compliance with Camber policies while fostering a solutions-focused environment built on the values of respect, accountability, and integrity.

Direct supervision of Utilization Review Specialists to ensure task completion and policy compliance. Managing telephonic interfaces with health plans to provide clinical information developed by treatment teams. Leading departmental operations including oversight of responsibilities, performance evaluations, and approval of workflow. Compiling and managing utilization review data with high attention to detail and accuracy. Communicating effectively with diverse constituencies, including families, community partners, and service agencies. Maintaining the highest standards of confidentiality and adhering to JIAC and KVC regulatory procedures. Participating actively in treatment team meetings and staff conferences to ensure continuity of care.

Requirements

• All applicants must be at least 20 years of age.
• Bachelor’s degree in a human service field such as social work, education, sociology, psychology, counseling, human relations, or criminal justice.
• A minimum of two years of experience in Utilization Review and at least one year of experience in a leadership role.
• Valid driver’s license and auto insurance.
• Intermediate proficiency with Microsoft Office, specifically Word, Excel, and Outlook.
• Strong command of the English language, both verbal and written, to conduct official administrative and operational business.

Preferred Qualifications

Bachelor’s degree in social work with licensure through the Missouri Division of Professional Registration (MOPRO) or the Kansas Behavioral Sciences Regulatory Board. Experience working with economically disadvantaged, vulnerable, or at-risk youth and young adults.

Why Camber?

At Camber, we believe that people matter. We expect our team members to be role models for children and families, using strengths-based approaches to achieve positive outcomes. We provide a professional environment where continuous improvement is encouraged and where your leadership directly impacts the wellbeing of our community.

Camber is an equal opportunity employer and will consider reasonable accommodations, consistent with applicable law, to enable qualified individuals with disabilities to perform the essential functions of the role.