Utilization Review Manager

Utilization Review Manager

Reports to: CEO

Job Category: Salaried Exempt Full-Time

Starting Salary: $75000-$95000/year (DOE)

Job Site: Remote (must reside in Colorado)

Job Summary:

The Utilization Review Manager is responsible for overseeing utilization review activities to ensure medical necessity regulatory compliance and timely authorization of behavioral health services. This role manages the utilization review team collaborates with clinical and administrative leadership and supports optimal patient care while maximizing reimbursement and minimizing denials.

Education and Experience:

• Bachelors degree required.
• Active clinical license required (RN LCSW LMFT LPC or equivalent); DORA registered.
• Minimum of 3 years of utilization review or care management experience in behavioral health.
• Minimum of 1 year of supervisory or management experience.
• Strong knowledge of medical necessity criteria and behavioral health levels of care.
• Familiarity with major commercial and government payors.

Required Skills/Abilities:

• Leadership and team management.
• Attention to detail and strong documentation review skills
• Excellent organizational analytical and communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Professional communication with payors and clinical staff.
• Data-driven decision making skills.
• Proficient with EHR systems and utilization management tools.
• Proficient with Google Workspace or related software.

Duties/Responsibilities:

• Manage and supervise the Utilization Review team including hiring training scheduling and performance management.
• Oversee authorization and reauthorization processes for behavioral health services across payors.
• Ensure compliance with federal state and payor-specific regulations and guidelines.
• Review clinical documentation to confirm medical necessity and completeness.
• Serve as the primary escalation point for complex cases denials and peer-to-peer reviews.
• Track and analyze utilization metrics authorization turnaround times and denial trends.
• Collaborate with clinical leadership to improve documentation practices and treatment planning.
• Develop and maintain utilization review policies procedures and workflows.
• Support audits accreditation reviews and quality improvement initiatives.
• Communicate effectively with insurance companies clinicians and internal stakeholders.
• Other duties as assigned.

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Standing sitting bending reaching.
• Must be able to see hear talk read write type.
• Exposure to clinical and medical environments.
• Must be able to lift 15 pounds at times.
• Driving in all weather conditions.

Benefits & Perks:

Health and Wellness

• Medical dental and vision insurance*
• Supplemental accident and hospital indemnity coverage*
• Voluntary Term Life insurance*
• Employee Assistance Program
• Monthly wellness reimbursement*

Financial

• Competitive salary
• Employee recognition and rewards programs
• Employee referral incentive program
• Employer-sponsored 401(k) plan

Work/Life Perks

• Professional growth and development
• Continuing education reimbursement
• Unlimited paid time off (exempt employees) sick days
• Paid time off policy (non-exempt employees) sick days
• Paid holidays (exempt) or ability to earn 1.5x base hourly rate (non-exempt)

*Full-time employees

This description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities required. Duties responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Accepting applications on an ongoing basis.