The Utilization Management Manager is responsible for leading the UM department to ensure appropriate utilization practices and maximize reimbursement while meeting client needs
Job Summary
The Utilization Management Manager is responsible for leading the UM department to ensure appropriate utilization practices and maximize reimbursement while meeting client needs.
The role involves supervising staff, coordinating with admissions, managing insurance appeals, and ensuring compliance with regulatory and clinical standards.
Raleigh Recovery Center offers a comprehensive benefit plan and competitive salary, and encourages veterans and military spouses to apply.
Matching Summary
The Utilization Management Manager is responsible for leading the UM department to ensure appropriate utilization practices and maximize reimbursement while meeting client needs.
Skills & Requirements
Must-have
Utilization review management
Insurance verification compliance
Supervision of clinical staff
Coordination with admissions department
Insurance appeals management
Utilization of client provider benefits
Nice-to-have
Team leadership and coaching
Problem solving and issue mitigation
Quality assurance review participation
Liaison with Medicaid reviewers
Key Requirements
High School Diploma or equivalent
Bachelor's degree preferred in related health field
Two or more years clinical experience in substance abuse
Two or more years medical/psychiatric utilization management experience