Utilization Manager, SUD Residential Compliance Lead

Noble Hearts HR Consulting Inc.; New York (NY); On-site; USD 59,000 - 72,000; Full time

Benefits offered by this job

15 Vacation Days

12 Sick Days

1 Floating Holiday

401(k) with 3% match

Job summary

Noble Hearts HR Consulting Inc. seeks an experienced Utilization Manager to oversee utilization management in an OASAS Part 820 program in Corona, Queens.

The role ensures services meet medical necessity and regulatory standards while coordinating with clinical, billing, and administrative leadership. The candidate should have strong organizational, analytical, and communication skills, with experience in residential SUD services and familiarity with LOCADTR and EHR systems.

Qualifications

• Master's degree in Social Work, Psychology, Health Administration, or related field; required/preferred per program needs.
• 2–3 years of experience in substance use disorder treatment, behavioral health, utilization management, or related healthcare setting.
• Knowledge of OASAS Part 820 regulations and LOCADTR criteria.
• Experience with Medicaid and Managed Care Organizations (MCOs).
• Casac, LMSW, LMHC, or related behavioral health credential preferred.
• Experience in residential or stabilization-level SUD services preferred.
• Familiarity with EHRs and utilization management platforms.

Responsibilities

• Monitor admissions, continued stays, and discharges for compliance with OASAS Part 820 and medical necessity criteria.
• Conduct regular utilization reviews to ensure appropriate placement across levels of care.
• Ensure timely completion and submission of LOCADTR assessments, treatment plans, progress updates, and utilization documentation.
• Maintain compliance with OASAS, Medicaid, and MCO requirements.
• Serve as liaison with MCOs and OASAS representatives regarding authorizations and utilization matters.
• Collaborate with clinical leadership to identify barriers to care and support timely transitions.
• Track authorization status and follow up on pending authorizations to minimize disruptions.
• Analyze utilization data including census, length of stay, and level-of-care trends.
• Prepare for audits, quality assurance reviews, and regulatory inspections.

Skills

Regulatory compliance

Documentation skills

Analytical thinking

Interpersonal skills

Project coordination

Education

Master's degree

Tools

EHR software

Utilization management platforms

Job description

Noble Hearts HR Consulting Inc. seeks an experienced Utilization Manager to oversee utilization management in an OASAS Part 820 program in Corona, Queens.

The role ensures services meet medical necessity and regulatory standards while coordinating with clinical, billing, and administrative leadership. The candidate should have strong organizational, analytical, and communication skills, with experience in residential SUD services and familiarity with LOCADTR and EHR systems.