Manager, Utilization Review

Bradford Health Services provides addiction treatment programs, resources, and community for every aspect of recovery. Through our premier drug and alcohol rehab facilities across the Southeast, we provide affordable, evidence-based addiction treatment with proven outcomes at every level of care. We’re guided by unity and dedicated to meeting and treating every patient right where they are. Bradford is more than a healthcare network; we are recovery communities for every stage of the journey.

We are seeking a Utilization Review Manager to add to our dynamic team! The Utilization Review Manager plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of patient records, treatment plans, and clinical data to determine the appropriateness of care and resource utilization. The specialist collaborates closely with healthcare providers, insurance companies, and case managers to facilitate timely approvals and optimize patient outcomes. By applying clinical knowledge and regulatory guidelines, the role helps control healthcare costs while maintaining high-quality patient care. Ultimately, the Utilization Review Specialist contributes to the integrity and sustainability of healthcare delivery systems across the United States.

Responsibilities

Oversee the coordination of the facility's insurance certification including precertification and continued stay reviews, as well as insure all insurance denials, appeals and reconsiderations are completed in a timely manner

Know and abide by the general provisions of 42 CFR Part 2, “Confidentiality of Drug and Alcohol Abuse Patient Records”, and 45 CFR “Health Insurance Portability and Accountability Act.” This position has unrestricted access to patient identifying and patient health information.

Coordinate and manage the day-to-day activities of the Utilization Review Staff

Complete daily reports and assign cases to the Utilization Coordinators, as well as coordinate with other departments as needed to complete the Utilization Review process

Ensure maintenance of "UR Activity Log", which records every review for the facility with financial classification and U.R. information/activity

Fill in as needed, or re-assign activities, to make sure all pre-certifications and continued stay reviews are completed in a timely manner

Review and maintain any correspondence pertaining to certification, appeals, denials or reconsiderations

Complete all Quality Improvement indicators for Utilization Management and report those indicators at the quarterly PIC meeting

Educate Counseling staff regarding documentation of patient care; and educate Crisis staff regarding intake assessments

Participate in the hiring, training, and evaluation of staff as necessary

Ability to work in a constant state of alertness as to perform the job safely

Ability to work in cooperative manner with co-workers, managers, clients and prospective managers

Regular attendance

Any other duties assigned by supervisor

Qualifications

Must have a current RN, LPC or LCSW license

Two years minimum experience in utilization review

Must possess good grammatical and communication skills

Must be skilled in Microsoft Office applications and have a working knowledge of office equipment

Must be able to see and read handwritten or printed notes and hear and/or interpret instructions (with or without corrective devices.)

Must be able to continuously sit for approximately 7 hrs. per 8 hr. shift

Must be able to walk within the facility a total of approximately two (2) hrs. per day

Must be emotionally and physically capable of functioning under stressful situations

If recovering, two years of continuous verifiable abstinence

We’re officially a Great Place to Work® ! We’ve always believed that supporting our team is just as important as supporting our patients. Now, we’re proud to share that we’ve earned Great Place to Work® Certification - based entirely on feedback from our own employees. Read more here: https://ow.ly/YQ1C50WuRH1

At Bradford Health Services, we are committed to providing exceptional care to our patients while fostering a supportive and rewarding workplace for our employees. We believe that taking care of our team allows them to take better care of others, which is why we offer a comprehensive benefits package designed to support their well-being.

Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits.

Expanded Coverage – Options for domestic partners and a wider network of in-network providers.

Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching.

Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more.

Student Loan Repayment – Available for nurses and therapists.

Retirement Benefits – 401(k) plan through Voya to help employees plan for the future.

Generous PTO – A robust paid time off policy to support work-life balance.

Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.