Utilization Manager

Elmcor Youth & Adult Activities Inc; New York (NY); On-site; USD 59,000 - 72,000; Full time

Benefits offered by this job

15 Vacation days Annually

12 Sick Days

Floating Holiday 1 annually

401K retirement plan with 3% match

Medical Benefits after 30 days

Dental/Vision eligible after 90 days

Access to Gym/Weight Room

Access to Boxing Ring

Short Term Disability

Life, Accidental Insurance via Aflac

Job summary

Elmcor Youth & Adult Activities Inc. seeks an Utilization Manager to oversee utilization management across the OASAS 820 program, ensuring medical necessity and regulatory compliance.

You will coordinate with clinical, medical, and administrative teams and report to the Clinical Director of residential services and Billing Manager. The role requires 2–3 years in SUD/behavioral health, mastery of LOCADTR criteria, and strong organization and communication skills.

Qualifications

• Master’s degree in Social Work, Psychology, Health Administration, or related field.
• 2–3 years 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.

Responsibilities

• Oversee admissions, stays, and discharges to align with OASAS Part 820 requirements.
• Conduct utilization reviews for appropriate levels of care (Stabilization, Rehabilitation, Reintegration).
• Ensure timely completion of LOCADTR assessments and treatment plans.
• Maintain compliance with OASAS, Medicaid, and MCO guidelines.
• Prepare for audits, quality reviews, and regulatory inspections.
• Liaise with MCOs, OASAS, and external partners on authorization requests.

Skills

Organizational skills

Communication skills

Analytical skills

Team collaboration

Education

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

Tools

EHR systems

Utilization management platforms

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Salary: $65,000.00 Annually

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.

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;
• Excellent time management, organizational, and computer software skills.
• Must be able to work independently and productively with minimum supervision.
• Team play with a “can do” attitude that can work in a fast paced environment.
• Ability to establish and maintain a professional atmosphere for employees.
• Performs job tasks in a manner that does not result in negative audit reviews.

BENEFITS:

• 15Vacation days Annually
• 12 Sick Days
• Floating Holiday 1 annually
• 401K retirement plan with 3% match after 90 days of employment
• Medical Benefits after 30 days of employment with Cigna
• Dental/Vision eligible after 90 days of employment
• Access to Gym/Weight Room
• Access to Boxing Ring
• Short Term Disability
• Life, Accidental Insurance available through Aflac