Senior Behavioral Health Utilization Review Manager

Garner Behavioral Hospital LLC; United States; On-site; USD 95,000 - 120,000; Full time

Job summary

Garner Behavioral Hospital LLC in North Carolina seeks an Utilization Review Manager for Behavioral Health to lead the UR department, oversee admissions reviews, and optimize patient placement and insurance coordination. You will supervise staff, ensure compliance with standards, and coordinate with admissions and the business office for smooth operations.

The role requires nursing licensure or related clinical field expertise, several years of UR/clinical experience, and CPR/de‑escalation

Qualifications

• Requires RN or LPN licensure in the state.
• Bachelor's degree in social work, behavioral health, or related field required.
• Master's degree in same field preferred.
• Minimum four years of clinical experience with the facility's population.
• Two+ years in medical/psychiatric utilization management and supervisory experience.
• CPR and de-escalation certification required.

Responsibilities

• Assigns and supervises Utilization Review staff to ensure timely insurance verifications.
• Ensures competency to review medical records for appropriateness of level of care.
• Leads hiring, orientation, performance assessment and coaching to meet dept goals.
• Works with Admissions to verify patient information and complete pre-certification.
• Appeals denials and coordinates correspondence to ensure accuracy.
• Analyzes records to determine admission/treatment/length of stay and compliance.
• Communicates with multidisciplinary staff and managed care to resolve issues.
• Oversees reviews (concurrent/retrospective) and supports quality assurance reviews.

Skills

Leadership

Staff supervision

Regulatory compliance

Interdepartmental coordination

Communication skills

Education

RN or LPN licensure

Bachelor's degree in social work or related field

Master's degree preferred

Job description

Garner Behavioral Hospital LLC in North Carolina seeks an Utilization Review Manager for Behavioral Health to lead the UR department, oversee admissions reviews, and optimize patient placement and insurance coordination. You will supervise staff, ensure compliance with standards, and coordinate with admissions and the business office for smooth operations.

The role requires nursing licensure or related clinical field expertise, several years of UR/clinical experience, and CPR/de‑escalation