Utilization Management Manager

Make a lasting impact in behavioral health care at Knoxville Center for Behavioral Medicine, a comprehensive inpatient facility providing compassionate, evidence-based treatment for adults and geriatric patients experiencing acute behavioral health crises or substance use disorders.

About the role

In this essential administrative role, you'll support the Utilization Management department to help ensure patients receive the care they need—when they need it—by coordinating with insurance providers, clinicians, and the larger care team.

Responsibilities

• Monitor utilization of continuum services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs.
• Responsible for the concurrent and retrospective review for all patients.
• Act as a liaison between Medicaid reviewers/gatekeepers and the staff completing required paperwork to facilitate the Utilization Review process.
• Work with physicians, therapists, and nursing staff to provide optimal review based on patient needs.
• Work with ancillary services to prevent delays in services.
• Review charts and make necessary recommendations to physicians regarding utilization review and specific managed care issues.
• Provide oversight and direction to utilization staff.

Requirements

• Bachelor's degree in Nursing or another clinical field.
• Minimum of 2 years of experience in the behavioral health field.
• Comfortable interacting with healthcare professionals and insurance providers.
• Skilled at managing multiple priorities in a fast-paced environment.
• Strong communicator who can clearly explain clinical situations and advocate for patient care.

Qualifications

Certification as a Registered Addiction Specialist, Certified Substance Abuse Counselor, or a similar credential is preferred.

Benefits

• Be part of a mission-driven organization committed to behavioral health recovery and wellness.
• Work in a supportive, team-based environment that values your contributions.
• Play a key role in helping patients access vital care and support.
• Enjoy opportunities for professional growth and career advancement.

Schedule

May require some flexibility based on workload.

Position Type: Full-Time
Location: Knoxville, TN