CareSource · 13 hours ago
Manager, Utilization Management - MSL/RN - Behavioral Health
United States
Full-time
Remote
Mid, Senior Level
$83K/yr - $133K/yr
5+ years expCareSource is a healthcare organization focused on providing quality services. The Manager, Utilization Management Behavioral Health is responsible for overseeing behavioral health utilization management activities, ensuring consistency in services, and achieving utilization targets.
Health CareMedicalNon Profit
Responsibilities
Assist in coordination and management of the pre-determination process of behavioral health services; ensure the consistent application of criteria for authorization decision, and that decisions to deny or reduce services are made by a health care professional who has appropriate clinical expertise
Assist in the development of integrated service delivery to members and oversee behavioral health utilization management data and processes to maintain industry standards and practices including decisions within allowable timeframes
Interact with providers and staff to manage benefits aligned with state-based regulations, NCQA and/or URAC regulations, and CareSource policies
Review and revise workflows to maximize efficiencies
Monitor productivity and utilization trends
Oversee CQI activities and ensure audits and staff feedback occur at regular intervals
Regularly report all utilization management regulatory requirements
Ensure compliance with and reporting of all regulatory requirements
Maintain all behavioral health utilization management reporting and trend data
Analyze under and over utilization information for impact on member quality of care and outcomes and formulate recommendations based on data
Develop, maintain and update all departmental policies and procedures; ensure notices of adverse action are provided in accordance with required regulations
Audit predetermination requests, cases for documentation and interrater reliability per CareSource policy
Act as liaison with other departments to assist with research and intervention
Performs any other job related duties as requested
Qualification
Required
Associates degree in Nursing, behavioral health or related field required
Five (5) years of clinical experience required
Five (5) years of experience in one of the following: behavioral health, case management, utilization management, and/or quality improvement required
One (1) year Leadership experience required
Current, unrestricted licensure in state of practice as a Registered Nurse (RN), Licensed Social Worker (LSW), Psychologist, or Professional Clinical Counselor (PCC) required
Beginning Excel, Word and PowerPoint experience
Experience in data analysis and trending
Knowledge of utilization management standards and practices
Communication skills
Management and prior supervisory skills
Ability to work independently and within a team environment
Attention to detail
Familiarity of the health care field
Critical listening and thinking skills
Training/teaching skills
Strategic management skills
Negotiation skills/experience
Proper grammar usage
Change resiliency
Technical writing skills
Time management skills
Proper phone etiquette
Customer service oriented
Decision making/problem solving skills
Leadership experience and skills
Preferred
Bachelor's Bachelor's degree preferred
Two (2) years utilization management experience preferred
Managed Care experience preferred
Benefits
You may qualify for a bonus tied to company and individual performance
Substantial and comprehensive total rewards package
Company
CareSource
CareSource provides managed care services to Medicaid beneficiaries.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
FHLB Cincinnati
2026-01-17Grant
Leadership Team
Erhardt Preitauer
President & Chief Executive Officer
Jason Bearden
Market President and CEO, Georgia
Recent News
2026-01-18
Dayton Daily News
2025-12-17
Company data provided by crunchbase