Remote Utilization Review Manager - Behavioral Health

KVC Health Systems, Inc.; Missouri; Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

PTO

Paid Parental Leave

Insurance Coverage (Health, Dental, V&

Job summary

KVC Health Systems, Inc. is seeking a detail-oriented Utilization Review Manager (URM) to serve as a key link between treatment teams, funding sources, and external partners.

This remote statewide Missouri role focuses on obtaining and reviewing clinical and medical service authorizations to support high-quality behavioral healthcare for children and families. The URM will collaborate with admissions and clinical teams, analyze data to support treatment recommendations, and ensure compliant

Qualifications

• Master’s Degree in Social Work, Counseling, Psychology, or related field; OR an Associate degree in Nursing.
• RN license highly preferred; LPN licensure considered with experience.
• Experience with commercial and managed Medicaid behavioral health plans.
• Knowledge of CPT coding for behavioral health services and DSM classifications.
• Experience with accounting or claims for billing resolution.
• Valid Class E Driver’s License.

Responsibilities

• Liaise between KVC treatment teams and external funding partners to manage clinical service reviews.
• Secure initial and continued inpatient stay authorizations through communication with funding source departments.
• 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

Clinical knowledge

Communication skills

Analytical ability

Time management

Cultural competency

Remote collaboration

Education

MSW or related field

ASN/ADN Nursing

Tools

Excel

Word

Outlook

Job description

KVC Health Systems, Inc. is seeking a detail-oriented Utilization Review Manager (URM) to serve as a key link between treatment teams, funding sources, and external partners.

This remote statewide Missouri role focuses on obtaining and reviewing clinical and medical service authorizations to support high-quality behavioral healthcare for children and families. The URM will collaborate with admissions and clinical teams, analyze data to support treatment recommendations, and ensure compliant