UR Analyst Manager

Role overview

Provident HealthCare Management is hiring a UR Analyst Manager to support compassionate, evidence-based behavioral health and addiction treatment services. The position focuses on reviewing clinical records to confirm medical necessity, appropriate level of care, and alignment with payer rules, while also helping the organization protect reimbursement and maintain quality standards for clients receiving treatment.

The ideal candidate should also have experience building a utilization review function from the ground up or making substantial improvements to an existing UR department.

Key responsibilities

• Complete initial and concurrent utilization reviews across all treatment levels, including Detox, Residential, PHP, IOP, and Outpatient.
• Confirm Medicaid/MCO eligibility and benefits before a client is admitted.
• File initial authorization requests for 3.5, 3.1, and 2.5 levels of care.
• Handle peer-to-peer discussions and appeals.
• Partner with clinical and medical staff to strengthen documentation for payer compliance.
• Track authorizations, denials, appeals, and review deadlines to ensure nothing is missed.
• Work closely with the Accounts Receivable team to keep records accurate and manage payer portal requests.
• Support audits and help ensure compliance with state, federal, and accreditation requirements.
• Prepare peer-to-peer review templates and materials for nurse practitioners.
• Maintain census tracking, authorization dates, and review due dates.
• Create weekly utilization and denial reports.
• Apply ASAM criteria knowledge in review and authorization work.
• Follow up on denials promptly and ensure appeals are submitted on time.
• Communicate with insurance case managers and advocate for client care needs.
• Coordinate discharge, step-down coverage, and aftercare planning.
• Take on additional duties as needed by the facility.

Qualifications

• Bachelor’s degree in Nursing, Social Work, Psychology, or a related discipline; RN or LCSW is preferred.
• At least 5 years of experience in utilization review, ideally in behavioral health or addiction treatment.
• Working knowledge of insurance authorization procedures.
• Strong verbal and written communication, organization, and documentation skills.
• Previous leadership experience.

Benefits

• Competitive compensation package
• Medical, dental, and vision coverage
• Vacation benefits
• Paid time off
• Tuition reimbursement
• Supportive work culture
• Regular employee appreciation and recognition

Equal opportunity statement

The employer provides equal employment opportunities and affirmative action consideration. All qualified candidates are welcome and will be evaluated without discrimination based on race, creed, color, national origin, age, sex, pregnancy, sexual orientation, gender identity, genetic information, religion, associational preferences, disability status, or veteran status.