Utilization Manager

Socket.dev

New York (NY)

On-site

USD 90,000 - 120,000

Full time

9 days ago

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Benefits offered by this job

Vacation days 15

Sick days 12

Floating holiday

401K with 3% match

Medical benefits

Dental/Vision

Gym/weight room

Transit Chek

PSLF eligibility

Life insurance

Legal Shield

Job summary

Socket.dev is seeking an Utilization Manager in Corona, Queens, NY, to oversee utilization management under the OASAS Part 820 program. You will coordinate admissions, discharges, and level-of-care decisions alongside clinical, medical, and administrative teams.

The role reports to the Billing Manager and involves ensuring documentation, LOCADTR assessments, and progress updates meet regulatory standards, with a schedule that includes some evenings and weekends.

Qualifications

Master’s degree in Social Work, Psychology, Health Administration, or related field.
2–3 years of experience in substance use disorder treatment, behavioral health, or utilization management.
Knowledge of OASAS Part 820 regulations and LOCADTR criteria.
Experience with Medicaid and managed care organizations.
CASAC, LMSW, LMHC, or related credential.

Responsibilities

Monitor admissions, stays, and discharges to ensure OASAS 820 and medical necessity compliance.
Conduct utilization reviews to determine appropriate level of care.
Ensure timely LOCADTR assessments, treatment plans, and progress updates.
Maintain compliance with OASAS, Medicaid, and MCO guidelines.
Prepare for audits, quality reviews, and regulatory inspections.
Liaise with MCOs, OASAS, and external partners for authorizations.
Collaborate with clinical leadership to address barriers to care.
Communicate utilization trends and recommendations to leadership.
Track census, length of stay, authorizations, and service patterns.
Generate reports for leadership and regulators as required.
Identify trends and suggest improvements for efficiency and outcomes.
Provide staff training on utilization requirements and documentation.

Skills

Organizational skills

Communication skills

Analytical skills

Interpersonal skills

Problem solving

Education

Master’s degree in Social Work, Psychology, Health Administration, or related field

Tools

EHR systems

Job description

JOB TITLE:

Utilization Manager

SUMMARY:

The Utilization Manager is responsible for overseeing and coordinating all utilization management activities within the OASAS 820 program. This role ensures that services are delivered in accordance with regulations, medical necessity criteria, and organizational standards. The Utilization Manager works closely with clinical, medical, and administrative teams to optimize service delivery, support appropriate levels of care, and maintain compliance with all documentation and reporting requirements. The Utilization manager will be reporting to the Clinical director of residential services. This position reports to the Billing Manager.

REPORTING RELATIONSHIP:

This position reports to theBilling Manager

SCHEDULE:

10AM - 6PM, flexibility in schedule to include some evenings and weekends based on program need.

LOCATION:

Corona, Queens NY

POSITION TYPE:

Fulltime - requires flexibility to cover shifts in the event of staffing shortages or emergencies

ESSENTIAL DUTIES/RESPONSIBILITIES:

Monitor and review all admissions, continued stays, and discharges to ensure alignment with OASAS Part 820 requirements and medical necessity.

Conduct regular utilization reviews to ensure appropriate level‑of‑care placement (Stabilization, Rehabilitation, and Reintegration).

Ensure timely completion and submission of required documentation, including LOCADTR assessments, treatment plans, and progress updates.

Maintain compliance with OASAS, Medicaid, and managed care organization (MCO) guidelines.

Prepare for and participate in audits, quality reviews, and regulatory inspections.

Serve as the primary liaison with MCOs, OASAS representatives, and external partners regarding authorization, continued stay requests, and service utilization.

Collaborate with clinical leadership to identify barriers to care and support timely transitions between levels of care.

Communicate utilization trends, concerns, and recommendations to program leadership.

Track and analyze utilization data, including census, length of stay, authorization status, and service patterns.

Generate regular reports for internal leadership and regulatory bodies as required.

Identify trends and recommend improvements to enhance service efficiency and outcomes.

Participate in quality improvement initiatives related to documentation, service delivery, and regulatory compliance.

Provide training and support to staff on utilization requirements, documentation standards, and best practices.

QUALIFICATIONS:

Master’s degree in Social Work, Psychology, Health Administration, or related field

Minimum 2–3 years of experience in substance use disorder treatment, behavioral health, or utilization management.

Knowledge of OASAS Part 820 regulations and LOCADTR criteria.

Experience working with Medicaid and managed care organizations.

CASAC, LMSW, LMHC, or related credential.

Experience in residential or stabilization-level SUD services.

Familiarity with electronic health records (EHR) and utilization management platforms.

Strong organizational, communication, and analytical skills

OTHER SKILLS/ABILITIES:

Must have strong interpersonal skills to support leadership, management, negotiation and problem-solving functions of this role.

Friendly, courteous, service-orientated, professional, outgoing, and client service oriented.

Outstanding detail oriented skills while maintaining an extremely positive attitude.

Excellent verbal and written communication skills; draft clear and concise text for producing documents, evaluations and other reports and policies and procedures of high professional quality;