The Utilization Review Manager (URM) serves as the liaison between Great Circle treatment teams, funding sources, and external partners to obtain and review all clinical and medical services for clients at Great Circle locations.

The URM communicates effectively with the funding source departments to secure initial and continued inpatient stay authorizations, obtain transitional care authorizations, and provide discharge information when the client is discharged from services.

The URM works closely with admissions and statewide clinical teams to collect and analyze data supporting treatment recommendations. The URM approves clinical documentation completed by program staff. The URM reports to the Utilization Review Manager Supervisor.

Required Education and Experience

• Master’s Degree in Social Work, Counseling, Psychology or related field OR associate degree in Nursing

• Missouri Provisional Licensure: Provisional Licensed Professional Counselor (PLPC), Licensed Master Social Worker (LMSW), Provisional Licensed Marriage and Family Therapist (PLMFT) OR Registered Nurse

• Experience working with commercial and managed Medicaid behavioral health plans.

• Experience securing continued stay authorizations for mental health services, solid working knowledge of the current CPT coding for behavioral health services, and familiarity with DSM diagnostic classification.

• Prior work experience working with accounting/claims for billing resolution

Preferred Education and Experience

• Experience working with children and families in a trauma informed environment

• Experience working in a residential setting

Qualifications

• Knowledge of clinical theory, therapy, and systems

• Skill to effectively communicate psychiatric and medical information

• Knowledge of community wrap-around services

• Strong customer service focus

• Excellent time management

• Analytical ability necessary to handle moderately complex administrative details such as preparing nonrecurring reports

• Independent judgment to plan, prioritize and organize a diversified workload with attention to detail

• Ability to work productively and respectfully with individuals and families from diverse cultural backgrounds

• Understanding of mental health and substance abuse for children, adolescents, and adults

• Ability to coordinate with local and remote clinical team members in both in person and utilizing electronic communication methods

• Proficiency with various PC based software program i.e. Excel, Word, Outlook, etc.

• Superior oral and written communication

• Class E Driver’s License

Benefits:

• Paid time off
• Paid Parental Leave
• Health, Dental, Vision & Life insurance
• 403b with company match
• Tuition reimbursement up to $21,000.00
• Employee assistance program
• Wellness benefits like health screenings, & mental health support

Why KVC?

KVC is a nonprofit child placing and behavioral health agency with a long legacy of compassionately serving children and families. We are committed to providing our employees with a supportive and rewarding work environment. We also believe in the importance of work-life balance, and we offer a variety of programs and resources to help our employees achieve it (Wellbeing Committee, DEI B Committee, Talent Development Programs, etc.).

At KVC Health Systems, our employees are our greatest asset. Based on the voice of our employees, KVC debuted with a 77 Work Wellbeing score on Indeed, a rating so high and rare that it places KVC among the top 1% of employers nationally. We are committed to providing a positive, supportive work environment where you can do your best work and love coming to work every day.

If you are a compassionate and caring individual who is looking for a rewarding career in the mental health/social services field, then we encourage you to apply.

To learn more about this position or to apply, please visit our website at www.kvc.org/jobs.

We hope you will consider joining our team!