Utilization Management Manager | Wooded Glen Recovery Center | Henryville, Indiana

About the Job:

Utilization Review Manager – Lead, Support & Shape Quality Care

Join a mission-driven team where your expertise in clinical documentation, insurance processes, and patient advocacy directly impacts client care and successful outcomes. As the Utilization Review (UR) Manager, you will lead a highly engaged team, streamline workflows, and ensure regulatory compliance—all while supporting clients’ access to necessary treatment.

Roles and Responsibilities:

What We’re Looking For

Education & Experience

• High School Diploma or equivalent required

• Preferred: Graduation from an accredited Nursing program (LPN/RN) or Bachelor’s degree in social work, behavioral health, mental health, or a related field

• 2+ years of clinical experience in a substance abuse setting REQUIRED

• 2+ years of utilization management experience in medical/psychiatric care REQUIRED

• Strong knowledge of admission, concurrent, continued-stay, and retrospective review criteria

Skills & Competencies

• Exceptional communication skills across multidisciplinary teams

• Ability to provide clear, concise, clinically accurate information using technical language

• Strong critical thinking, problem solving, and attention to detail

• Ability to navigate managed care processes with confidence

Supervisory Requirements

• Minimum 1 year of supervisory experience in a clinical or utilization review setting

What You’ll Do (Key Responsibilities)

Lead & Support a High-Performing UR Team

• Assign caseloads to UR staff and oversee timely, accurate insurance verifications

• Hire, train, motivate, and coach team members to meet department goals

• Conduct performance assessments, orientation, scheduling, and ongoing development

Ensure Accurate Assessments & Compliance

• Review medical records to evaluate appropriate level of care at admission and throughout treatment

• Ensure staff competencies meet internal and external regulatory standards

• Monitor charting accuracy and ensure deficiencies are resolved quickly

• Identify cases for Medical Director review based on complex clinical or documentation factors

Collaborate Across Departments

• Partner with Admissions to ensure complete and accurate pre-certification

• Approve admissions or escalate cases to the UR Committee when criteria are not met

• Communicate coverage issues with clinical, nursing, medical, and administrative teams

• Coordinate with the business office to prevent or resolve payment concerns

Manage Insurance Processes & Appeals

• Resolve discrepancies in benefit information and insurance verification

• Appeal insurance denials with accurate, complete documentation and timely submissions

• Conduct concurrent and retrospective reviews for all clients

• Serve as the liaison for Medicaid reviewers and support staff submitting required documentation

Drive Quality & Adherence to Standards

• Analyze client records to ensure appropriateness of admission, treatment plans, and length of stay

• Apply insurance, government, and accrediting standards to uphold facility compliance

• Assist in quality assurance activities and review committee planning

Why Wooded Glen Recovery Center?Wooded Glen Recovery Center offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Wooded Glen Recovery Center is an EOE.

Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.