Utilization Review Manager at GRO Community

Job Title: Utilization Review ManagerLocation: Chicago Job Type: Full-TimeReports to: Director of Revenue Cycle Manager; In Direct Reporting to Chief Clinical OfficerDirect Reports: none subject to change in futureAbout Us:God Restoring Order (GRO) Community is a mental healthcare provider that specializes in trauma recovery services for males of color ages 5 and up. GRO services are grounded in an understanding of the neurological biological and psychological effects of trauma. GRO services include mental health and wellness stress management and community outreach.Position Summary:The Utilization Review Manager (URM) is responsible for coordinating and monitoring clinical documentation and service authorizations to ensure medical necessity regulatory compliance and optimal reimbursement. This role serves as a key liaison between clinical staff payers and administrative teams to support timely and accurate utilization management while maintaining quality-of-care standards. The URS will also facilitate utilization review processes across departments and coordinate appropriate client step-downs when clinically indicated.Key Responsibilities:Utilization Review & Authorization ManagementConduct ongoing utilization reviews of client treatment plans progress notes and service delivery to ensure alignment with payer and regulatory requirements.Coordinate with insurance companies by submitting all required documentation and addressing any disputes or discrepancies.Submit track and follow up on initial and continued service authorization requests with insurance carriers and funding sources. Monitor and analyze denial trends proactively identifying opportunities to improve documentation and authorization processes. Maintain detailed records of authorization status denials and appeal outcomes.Clinical Documentation OversightCollaborate with clinicians to ensure treatment plans assessments and progress notes meet clinical and payer criteria.Provide guidance and training to staff on documentation standards related to utilization review and medical necessity.Participate in internal audits and assist in developing corrective action plans when deficiencies are identified.Communication & CoordinationServe as the primary point of contact for payer representatives regarding authorizations reauthorizations and claims-related issues.Partner with the revenue cycle team to reconcile service utilization against approved authorizations.Work closely with Clinical Operations and Counseling supervisors to monitor caseload utilization and prevent service gaps or overages.Compliance & ReportingEnsure adherence to HIPAA Medicaid and managed care regulations.Maintain up-to-date knowledge of payer requirements industry standards and policy changes affecting utilization management.Prepare and present utilization and authorization reports to leadership identifying patterns and recommendations for improvement.Competencies:Regulatory & Compliance KnowledgeCritical Thinking & Problem SolvingClinical Documentation ReviewCommunication & CollaborationTime Management & PrioritizationIntegrity & Confidentiality Work Setting:Standard office setting.May require occasional travel to clinical sites or payer meetings.Qualifications:Education: Masters degree in Nursing Psychology Social Work Health Administration or related field requiredExperience: Minimum 35 years of utilization review case management or clinical documentation experience in a healthcare behavioral health or managed care environment.Licensure/Certification: Active LCSW or LCPC clinical licensure highly preferred.Skills:Strong knowledge of insurance authorization processes and payer criteria.Excellent analytical and communication skills.High attention to detail and ability to manage multiple cases simultaneously.Proficiency in EHR systems and Google Office Suite.What We Offer:Competitive salary and benefits package.A supportive and dynamic work environment committed to social impact.Opportunities for professional development and growth.How to Apply:At GRO Community we believe in healing through empowerment and innovation. Our work centers on serving individuals and families with compassion and integrity. Join our team to make a meaningful impact while building your professional skills in a supportive and mission-driven environment.Interested candidates should submit a resume and cover letter detailing their relevant experience to Required Experience:Manager Key Skills Restaurant Experience,Customer Service,Employee Evaluation,Management Experience,Math,Employment & Labor Law,Sanitation,Leadership Experience,P&L Management,Mentoring,Supervising Experience,Restaurant Management Employment Type : Full Time Experience: years Vacancy: 1