Remote Utilization Review Manager - Behavioral Health

KVC Health Systems, Inc.; Clayton (MO); Remote; USD 75,000 - 105,000; Full time

Benefits offered by this job

Paid Time Off

Paid Parental Leave

Health, Dental, Vision & Life Health

403(b) with Company Match

Tuition Reimbursement

Professional Licensure and Cert Reimb.

Employee Assistance Program

Wellness Benefits

Job summary

KVC Health Systems is seeking a dedicated Utilization Review Manager to oversee clinical service authorizations for Missouri clients from remote locations statewide. You will liaise with treatment teams, funding sources, and admissions to secure inpatient stay and transitional care authorizations, review documentation, and support treatment decisions.

This role emphasizes data analysis, compliance, and collaboration across diverse clinical teams, with responsibilities centered on quality,

Qualifications

• Master’s degree in Social Work, Counseling, Psychology, or related field; OR Associate degree in Nursing.
• RN license preferred; LPN license considered with relevant experience.
• Experience with commercial and managed Medicaid behavioral health plans.
• Experience securing continued stay authorizations for mental health services.
• Knowledge of CPT coding for behavioral health and familiarity with DSM classifications.
• Experience with billing or claims.
• Valid Class E Driver’s License.
• Experience in a residential setting and trauma-informed care is preferred.

Responsibilities

• Liaise between KVC treatment teams and external funding partners to manage clinical service reviews.
• Secure initial and continued inpatient stay authorizations through effective communication with funding source departments.
• Work collaboratively with admissions and statewide clinical teams to support treatment recommendations through data analysis.
• Approve clinical documentation to ensure compliance and support for authorized services.
• Obtain transitional care authorizations and manage the flow of discharge information to partners.

Skills

Clinical theory

Communication skills

Wrap-around services knowledge

Data analysis

Time management

Cultural competence

MS Office

Remote coordination

Education

Master’s Degree in Social Work

Associate degree in Nursing

Job description

KVC Health Systems is seeking a dedicated Utilization Review Manager to oversee clinical service authorizations for Missouri clients from remote locations statewide. You will liaise with treatment teams, funding sources, and admissions to secure inpatient stay and transitional care authorizations, review documentation, and support treatment decisions.

This role emphasizes data analysis, compliance, and collaboration across diverse clinical teams, with responsibilities centered on quality,