Utilization Manager

Utilization Manager

Location: Corona, Queens, NY
Schedule: Monday-Friday, 10:00 AM-6:00 PM, Full-Time
Salary: 65K Annually
Schedule Flexibility: Some evenings, weekends, and coverage outside regular hours may be required based on program needs, staffing shortages, or emergencies.
Reports To: Billing Manager
Program: OASAS Part 820 Residential Services
Position Summary

The Utilization Manager is responsible for overseeing and coordinating utilization management activities within the OASAS Part 820 program. This position ensures that services are delivered in accordance with OASAS regulations, medical necessity criteria, Medicaid and managed care requirements, and organizational standards.

The Utilization Manager works closely with clinical, medical, billing, and administrative leadership to support appropriate levels of care, facilitate timely transitions, optimize service utilization, and maintain compliance with documentation, authorization, and reporting requirements.

The ideal candidate is highly organized, detail-oriented, analytical, and knowledgeable about substance use disorder treatment, residential services, utilization management, and regulatory requirements.
Essential Duties & Responsibilities

• Monitor and review admissions, continued stays, and discharges to ensure compliance with OASAS Part 820 requirements and medical necessity criteria.
• Conduct regular utilization reviews to ensure appropriate placement across levels of care, including Stabilization, Rehabilitation, and Reintegration .
• Ensure timely completion and submission of required documentation, including LOCADTR assessments, treatment plans, progress updates, and utilization review documentation .
• Maintain compliance with OASAS, Medicaid, and Managed Care Organization (MCO) requirements and guidelines.
• Serve as a primary liaison with MCOs, OASAS representatives, and external partners regarding authorizations, continued-stay requests, service utilization, and related matters.
• Collaborate with clinical leadership to identify barriers to care and support timely transitions between levels of care.
• Monitor authorization status and follow up on pending or expiring authorizations to minimize disruptions in services.
• Track and analyze utilization data, including census, length of stay, authorization status, service patterns, and level-of-care utilization .
• Generate regular utilization reports and communicate trends, concerns, and recommendations to program and organizational leadership.
• Identify opportunities to improve service efficiency, documentation practices, utilization outcomes, and regulatory compliance.
• Prepare for and participate in audits, quality assurance reviews, and regulatory inspections .
• Participate in quality improvement initiatives related to documentation, service delivery, utilization management, and compliance.
• Provide training, guidance, and ongoing support to staff regarding utilization requirements, documentation standards, regulatory expectations, and best practices.
• Maintain accurate and timely records in the organization's EHR and applicable utilization management systems.
• Work collaboratively with clinical, medical, billing, and administrative teams to ensure appropriate coordination of services.
• Perform job responsibilities in a manner that supports positive audit outcomes and minimizes compliance risks.
• Perform other related duties as assigned.

Qualifications

• Master's degree in Social Work, Psychology, Health Administration, or a related field preferred/required based on program requirements.
• Minimum 2-3 years of experience in substance use disorder treatment, behavioral health, utilization management, or a related healthcare setting.
• Knowledge of OASAS Part 820 regulations and LOCADTR criteria .
• Experience working with Medicaid and Managed Care Organizations (MCOs) .
• CASAC, LMSW, LMHC, or related behavioral health credential preferred.
• Experience working in residential or stabilization-level substance use disorder services strongly preferred.
• Familiarity with electronic health records (EHRs) and utilization management platforms.
• Strong organizational, analytical, communication, documentation, and problem-solving skills.
• Ability to interpret regulations, clinical documentation, utilization data, and medical necessity criteria.

Other Skills & Abilities

• Strong interpersonal skills with the ability to effectively support leadership, management, negotiation, and problem-solving functions.
• Professional, courteous, service-oriented, and approachable demeanor.
• Exceptional attention to detail while maintaining a positive and solutions-focused attitude.
• Excellent verbal and written communication skills, with the ability to prepare clear, concise, and professional documentation, reports, evaluations, policies, and procedures.
• Excellent time-management, organizational, and computer skills.
• Ability to work independently with minimal supervision while effectively collaborating with multidisciplinary teams.
• Strong ability to prioritize and manage multiple responsibilities in a fast-paced environment.
• Team-oriented with a proactive "can-do" attitude .
• Ability to establish and maintain a professional and respectful work environment.
• Strong commitment to regulatory compliance, documentation accuracy, confidentiality, and quality of care.
• Ability to perform responsibilities in a manner that supports successful audits and regulatory reviews.
• Flexibility to assist with program coverage when staffing shortages or emergencies arise.

Benefits

• 15 Vacation Days annually
• 12 Sick Days annually
• 1 Floating Holiday annually
• 401(k) Retirement Plan with 3% employer match after 90 days of employment
• Medical Insurance through Cigna after 30 days of employment
• Dental & Vision Insurance eligibility after 90 days
• Access to Gym/Weight Room
• Access to Boxing Ring
• Short-Term Disability
• Life & Accidental Insurance available through Aflac
• TransitChek for commuting expenses
• LegalShield legal services
• Potential eligibility for Public Service Loan Forgiveness (PSLF) for qualifying employees and employment

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