Senior Utilization Review Case Manager - Remote

Overview

The Senior Utilization Review (UR) Case Manager plays a key role in ensuring patients receive high-quality care by effectively coordinating with the Director of UR, VP of Clinical Operations, Division President, and treatment teams.

In Short

• Conduct weekly training sessions on effective documentation and utilization review.
• Provide onboarding and oversight for new hires on the utilization review process.
• Host weekly UR office hours to support clinical staff.
• Ensure teams understand UR protocols and processes.
• Provide direct oversight of decentralized facility charts.
• Train and support staff in completing peer reviews.
• Review documentation for clinical appropriateness and compliance.
• Contribute to quality and performance improvement initiatives.
• Conduct and manage initial insurance reviews and pre-authorizations.
• Support the CFD UR Team with urgent matters.

Requirements

• Master’s Degree preferred but not required.
• Licensed LMFT, LCSW, LVN, or RN preferred but not required.
• Strong knowledge of insurance and joint commission guidelines.
• Deep understanding of the therapeutic process and confidentiality laws.
• Strong interpersonal skills and ability to collaborate effectively.
• Exceptional verbal and written communication skills.
• Ability to handle difficult situations with a positive approach.
• Proficiency in electronic medical records (EMRs), particularly KIPU.

Benefits

• Opportunity to work in a growing team.
• Voice in the creation of life-changing programs.
• Supportive and diverse work environment.
• Competitive compensation based on experience and region.