Remote Utilization Review Manager — Behavioral Health Lead

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

Benefits offered by this job

PTO

403(b) with Company Match

Tuition Reimbursement

Professional Licensure Reimbursement

Employee Assistance Program

Job summary

KVC Health Systems, Inc. in Kansas City, MO is seeking a dedicated Utilization Review Manager (URM) to obtain and review clinical and medical service authorizations, supporting high-quality behavioral healthcare for children and families.

You will liaise with treatment teams and external partners to secure inpatient stay authorizations, provide discharge information, and analyze data to support treatment recommendations.

Qualifications

• Master’s in Social Work or related field, or an Associate degree in Nursing.
• RN license preferred; LPN considered with appropriate experience.
• Experience with commercial and managed Medicaid behavioral health plans.
• Knowledge of CPT coding for behavioral health and familiarity with DSM.
• Billing/resolution experience; valid Missouri driver’s license.

Responsibilities

• Liaise between treatment teams and external funding partners to manage clinical reviews.
• Secure initial and continued inpatient stay authorizations with 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

Clinical Review

Stakeholder liaison

Data analysis

CPT coding

DSM knowledge

Communication

Education

MSW

ASN/ADN RN

Tools

Excel

Word

Outlook

Job description

KVC Health Systems, Inc. in Kansas City, MO is seeking a dedicated Utilization Review Manager (URM) to obtain and review clinical and medical service authorizations, supporting high-quality behavioral healthcare for children and families.

You will liaise with treatment teams and external partners to secure inpatient stay authorizations, provide discharge information, and analyze data to support treatment recommendations.