What are the responsibilities and job description for the Utilization Management Manager position at Wooded Glen Recovery Center?
About the Job:
Utilization Review Manager – Lead, Support & Shape Quality CareJoin a mission-driven team where your expertise in clinical documentation, insurance processes, and patient advocacy directly impacts client care and successful outcomes. As the Utilization Review (UR) Manager, you will lead a highly engaged team, streamline workflows, and ensure regulatory compliance—all while supporting clients’ access to necessary treatment.
Roles and Responsibilities:
What We’re Looking For
Education & Experience
High School Diploma or equivalent required
Preferred: Graduation from an accredited Nursing program (LPN/RN) or Bachelor’s degree in social work, behavioral health, mental health, or a related field
2 years of clinical experience in a substance abuse setting REQUIRED
2 years of utilization management experience in medical/psychiatric care REQUIRED
Strong knowledge of admission, concurrent, continued-stay, and retrospective review criteria
Skills & Competencies
Exceptional communication skills across multidisciplinary teams
Ability to provide clear, concise, clinically accurate information using technical language
Strong critical thinking, problem solving, and attention to detail
Ability to navigate managed care processes with confidence
Supervisory Requirements
Minimum 1 year of supervisory experience in a clinical or utilization review setting
What You’ll Do (Key Responsibilities)
Lead & Support a High-Performing UR Team
Assign caseloads to UR staff and oversee timely, accurate insurance verifications
Hire, train, motivate, and coach team members to meet department goals
Conduct performance assessments, orientation, scheduling, and ongoing development
Ensure Accurate Assessments & Compliance
Review medical records to evaluate appropriate level of care at admission and throughout treatment
Ensure staff competencies meet internal and external regulatory standards
Monitor charting accuracy and ensure deficiencies are resolved quickly
Identify cases for Medical Director review based on complex clinical or documentation factors
Collaborate Across Departments
Partner with Admissions to ensure complete and accurate pre-certification
Approve admissions or escalate cases to the UR Committee when criteria are not met
Communicate coverage issues with clinical, nursing, medical, and administrative teams
Coordinate with the business office to prevent or resolve payment concerns
Manage Insurance Processes & Appeals
Resolve discrepancies in benefit information and insurance verification
Appeal insurance denials with accurate, complete documentation and timely submissions
Conduct concurrent and retrospective reviews for all clients
Serve as the liaison for Medicaid reviewers and support staff submitting required documentation
Drive Quality & Adherence to Standards
Analyze client records to ensure appropriateness of admission, treatment plans, and length of stay
Apply insurance, government, and accrediting standards to uphold facility compliance
Assist in quality assurance activities and review committee planning
Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.