Remote Utilization Review Manager – Behavioral Health

KVC Health Systems, Inc.; Kansas City (MO); Remote; USD 55,000 - 70,000; Full time

Benefits offered by this job

PTO

Parental leave

Insurance coverage

403(b) match

Tuition reimbursement

Licensure reimbursement

Employee Assistance Program

Job summary

KVC Health Systems, Inc. in Kansas City, MO is seeking a dedicated Utilization Review Manager to ensure clinical and medical services are reviewed and authorized across treatment teams.

The URM will obtain inpatient stay authorizations, coordinate with funding sources, and support discharge information in collaboration with statewide clinical teams. This role reports to the Utilization Review Manager Supervisor and requires a Master’s in social work or related field, RN licensure preferred.

Qualifications

• Master’s degree in Social Work, Counseling, Psychology, or related field.
• RN license preferred; LPN licensure will be considered with experience for this role.
• Experience with commercial and managed Medicaid behavioral health plans.

Responsibilities

• Liaise between treatment teams and external funding partners to manage clinical service reviews.
• Secure initial and continued inpatient stay authorizations through funding sources.
• Collaborate 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 discharge information to partners.

Skills

Time management

Organizational skills

Communication skills

Data analysis

Education

Master’s Degree in Social Work

Associate degree in Nursing

Tools

Excel

Word

Outlook

Job description

KVC Health Systems, Inc. in Kansas City, MO is seeking a dedicated Utilization Review Manager to ensure clinical and medical services are reviewed and authorized across treatment teams.

The URM will obtain inpatient stay authorizations, coordinate with funding sources, and support discharge information in collaboration with statewide clinical teams. This role reports to the Utilization Review Manager Supervisor and requires a Master’s in social work or related field, RN licensure preferred.