Location: Remote (Statewide - Missouri)
KVC Missouri is seeking a dedicated and detail-oriented Utilization Review Manager (URM) to serve as a vital link between our treatment teams, funding sources, and external partners. In this role, you will ensure that all clinical and medical services for our clients are reviewed and authorized, supporting our mission to provide high-quality behavioral healthcare to children and families.
Position SummaryThe Utilization Review Manager (URM) is responsible for obtaining and reviewing clinical and medical service authorizations for clients at Great Circle locations. You will communicate effectively with funding source departments to secure initial and continued inpatient stay authorizations, obtain transitional care authorizations, and provide necessary discharge information. Working closely with admissions and clinical teams statewide, you will analyze data to support treatment recommendations and approve clinical documentation completed by program staff.
This position reports to the Utilization Review Manager Supervisor.
Essential Duties and ResponsibilitiesLiaise between KVC treatment teams and external funding partners to manage clinical service reviews.
Secure initial and continued inpatient stay authorizations through effective communication with funding source departments.
Work collaboratively with admissions and statewide clinical teams to support treatment recommendations through data analysis.
Approve clinical documentation to ensure compliance and support for authorized services.
Obtain transitional care authorizations and manage the flow of discharge information to partners.
Education: Master’s Degree in Social Work, Counseling, Psychology, or a related field; OR an Associate degree in Nursing.
Licensure:
Registered Nurse (RN license is highly preferred); LPN licensure will be considered with appropriate experience for this role.
Experience:
Working with commercial and managed Medicaid behavioral health plans.
Securing continued stay authorizations for mental health services.
Solid working knowledge of current CPT coding for behavioral health services and familiarity with DSM diagnostic classification.
Experience with accounting or claims for billing resolution.
Other: Valid Class E Driver’s License.
Experience in a residential setting.
Experience working with children and families in a trauma-informed environment.
Deep understanding of clinical theory, therapy, and behavioral health systems.
Ability to effectively communicate complex psychiatric and medical information.
Knowledge of community wrap-around services and a strong customer service focus.
Analytical ability to handle administrative details and prepare nonrecurring reports.
Strong time management and organizational skills to handle a diversified workload with high attention to detail.
Ability to work productively with individuals and families from diverse cultural backgrounds.
Proficiency in PC-based software including Excel, Word, and Outlook.
Superior oral and written communication skills and the ability to coordinate across remote teams.
Benefits:
Paid Time Off
- Enjoy a generous amount of leave to support your work-life balance.
Paid Parental Leave
- Receive financial support during parental leave to help you spend quality time with your new family member.
Health, Dental, Vision & Life Insurance
- Comprehensive insurance coverage to keep you and your family healthy and protected.
403(b) with Company Match
- Retirement savings plan with company contributions to help you plan for your future.
Tuition Reimbursement
- Financial assistance for continuing education and professional development.
Professional Licensure and Certification Reimbursement
- Support for obtaining and renewing professional licenses and certifications.
Employee Assistance Program
- Confidential support for personal and professional challenges, including counseling and resources.
Wellness Benefits
- Access to health screenings and mental health support to promote overall well-being.
KVC Health Systems is a nonprofit organization with a long legacy of compassionately serving children and families. Our employees are our greatest asset, recently earning a 86 Work Wellbeing score on Indeed—placing KVC in the top 1% of employers nationally. We are committed to a supportive work environment where you can do your best work and find true work-life balance through our Wellbeing, DEI+B, and Talent Development programs.
How to ApplyIf you are a compassionate professional looking for a rewarding career in mental health and social services, we encourage you to join our team!
To learn more or to apply, please visit our website at www.kvc.org/jobs.
Skills Required
- Master's degree in social work, counseling, psychology, or a related field, or an associate degree in nursing
- Registered Nurse license
- LPN licensure with appropriate experience may be considered
- Experience working with commercial and managed Medicaid behavioral health plans
- Experience securing continued-stay authorizations for mental health services
- Working knowledge of CPT coding for behavioral health services
- Familiarity with DSM diagnostic classification
- Experience with accounting or claims for billing resolution
- Valid Class E driver's license
- Experience in a residential setting
- Experience working with children and families in a trauma-informed environment
- Proficiency with Excel, Word, and Outlook
What We Do
At KVC Health Systems, our 2,800 caring team members work every day to strengthen families, prevent child abuse and neglect, and help both children and adults achieve mental wellness. We all need connection! And at KVC, our employees are our greatest asset and strength, helping the people we serve experience the power of connection to themselves, their family and friends, and to professionals who can help them thrive. We're working toward a bold vision: a world in which every person is SAFE and CONNECTED to a strong family and a healthy community. No more child abuse and neglect. No more untreated mental illness or addiction. Parents no longer pass down the cycles of violence, substance use or trauma that they experienced as children. Instead, families have the skills and supportive connections they need to thrive. Every individual has unlimited possibilities and can reach their full potential. This is why the KVC team comes to work every day, providing family strengthening services, mental and behavioral healthcare, foster care, adoption and inpatient children’s mental health treatment. People are facing serious challenges, and community needs are greater than ever. Will you join us? Since 1970, KVC has grown from a single home for at-risk children to a national organization serving over 80,000 children and families each year in Kansas, Missouri, Nebraska, Kentucky and West Virginia. KVC also provides training and consultation around the world. We're a family of private, nonprofit 501(c)3 organizations committed to enriching and enhancing the lives of children and families. Learn more at www.kvc.org.
