Utilization Manager - Behavioral Health & Compliance

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

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.