Utilization Review Manager

KVC Health Systems, Inc.; Clayton (MO); Remoto; USD 75.000 - 105.000; Tempo pieno

Vantaggi offerti da questo lavoro

Paid Time Off

Paid Parental Leave

Health, Dental, Vision & Life Health

403(b) with Company Match

Tuition Reimbursement

Professional Licensure and Cert Reimb.

Employee Assistance Program

Wellness Benefits

Descrizione del lavoro

KVC Health Systems is seeking a dedicated Utilization Review Manager to oversee clinical service authorizations for Missouri clients from remote locations statewide. You will liaise with treatment teams, funding sources, and admissions to secure inpatient stay and transitional care authorizations, review documentation, and support treatment decisions.

This role emphasizes data analysis, compliance, and collaboration across diverse clinical teams, with responsibilities centered on quality,

Competenze

• Master’s degree in Social Work, Counseling, Psychology, or related field; OR Associate degree in Nursing.
• RN license preferred; LPN license considered with relevant experience.
• Experience with commercial and managed Medicaid behavioral health plans.
• Experience securing continued stay authorizations for mental health services.
• Knowledge of CPT coding for behavioral health and familiarity with DSM classifications.
• Experience with billing or claims.
• Valid Class E Driver’s License.
• Experience in a residential setting and trauma-informed care is preferred.

Mansioni

• Liaise between KVC treatment teams and external funding partners to manage clinical service reviews.
• Secure initial and continued inpatient stay authorizations through effective communication with funding source departments.
• Work collaboratively with admissions and statewide clinical teams to support treatment recommendations through data analysis.
• Approve clinical documentation to ensure compliance and support for authorized services.
• Obtain transitional care authorizations and manage the flow of discharge information to partners.

Conoscenze

Clinical theory

Communication skills

Wrap-around services knowledge

Data analysis

Time management

Cultural competence

MS Office

Remote coordination

Formazione

Master’s Degree in Social Work

Associate degree in Nursing

Descrizione del lavoro

Utilization Review Manager - KVC Missouri Admissions

Location: Remote (Statewide - Missouri)

KVC Missouri is seeking a dedicated and detail-oriented Utilization Review Manager (URM) to serve as a vital link between our treatment teams, funding sources, and external partners. In this role, you will ensure that all clinical and medical services for our clients are reviewed and authorized, supporting our mission to provide high-quality behavioral healthcare to children and families.

Position Summary

The Utilization Review Manager (URM) is responsible for obtaining and reviewing clinical and medical service authorizations for clients at Great Circle locations. You will communicate effectively with funding source departments to secure initial and continued inpatient stay authorizations, obtain transitional care authorizations, and provide necessary discharge information. Working closely with admissions and clinical teams statewide, you will analyze data to support treatment recommendations and approve clinical documentation completed by program staff.

This position reports to the Utilization Review Manager Supervisor .

Essential Duties and Responsibilities

• Liaise between KVC treatment teams and external funding partners to manage clinical service reviews.

• Secure initial and continued inpatient stay authorizations through effective communication with funding source departments.

• Work collaboratively with admissions and statewide clinical teams to support treatment recommendations through data analysis.

• Approve clinical documentation to ensure compliance and support for authorized services.

• Obtain transitional care authorizations and manage the flow of discharge information to partners.

Required Qualifications

• Education: Master’s Degree in Social Work, Counseling, Psychology, or a related field; OR an Associate degree in Nursing.

• Licensure:

  • Registered Nurse ( RN license is highly preferred ); LPN licensure will be considered with appropriate experience for this role.

• Experience:

  • Working with commercial and managed Medicaid behavioral health plans.

  • Securing continued stay authorizations for mental health services.

  • Solid working knowledge of current CPT coding for behavioral health services and familiarity with DSM diagnostic classification.

  • Experience with accounting or claims for billing resolution.

• Other: Valid Class E Driver’s License.

Preferred Qualifications

• Experience in a residential setting.

• Experience working with children and families in a trauma-informed environment.

Knowledge, Skills, and Abilities

• Deep understanding of clinical theory, therapy, and behavioral health systems.

• Ability to effectively communicate complex psychiatric and medical information.

• Knowledge of community wrap-around services and a strong customer service focus.

• Analytical ability to handle administrative details and prepare nonrecurring reports.

• Strong time management and organizational skills to handle a diversified workload with high attention to detail.

• Ability to work productively with individuals and families from diverse cultural backgrounds.

• Proficiency in PC-based software including Excel, Word, and Outlook.

• Superior oral and written communication skills and the ability to coordinate across remote teams.

Benefits:

Paid Time Off

• Enjoy a generous amount of leave to support your work-life balance.

Paid Parental Leave

• Receive financial support during parental leave to help you spend quality time with your new family member.

Health, Dental, Vision & Life Insurance

• Comprehensive insurance coverage to keep you and your family healthy and protected.

403(b) with Company Match

• Retirement savings plan with company contributions to help you plan for your future.

Tuition Reimbursement

• Financial assistance for continuing education and professional development.

Professional Licensure and Certification Reimbursement

• Support for obtaining and renewing professional licenses and certifications.

Employee Assistance Program

• Confidential support for personal and professional challenges, including counseling and resources.

Wellness Benefits

• Access to health screenings and mental health support to promote overall well-being.

Why Join KVC?

KVC Health Systems is a nonprofit organization with a long legacy of compassionately serving children and families. Our employees are our greatest asset, recently earning a 86 Work Wellbeing score on Indeed—placing KVC in the top 1% of employers nationally . We are committed to a supportive work environment where you can do your best work and find true work-life balance through our Wellbeing, DEI+B, and Talent Development programs.