Revenue Utilization Manager

Revenue Utilization Manager Full Circle Recovery Services - 3.3 Dayton, OH Job Details Full-time From $78,000 a year 1 day ago Qualifications Appeals Staff supervision Management Overseeing health insurance pre-certification Medicare Team leadership Provider enrollment for medical credentialing Medicaid health insurance Team development Driver's License Utilization management Problem-solving Mentoring Healthcare team management Medicaid regulations Medicaid Process management Behavioral health Full Job Description About the Company Full Circle Recovery Services is an outpatient treatment center dedicated to making a real difference in Dayton and its surrounding areas. With a personalized approach to care, we focus on addressing the individuals' unique needs of those struggling with addiction. Our programs are designed to help clients overcome life's challenges, eliminate barriers, and combat the stigma surrounding their addiction. Position Summary The Revenue Utilization Manager oversees insurance operations to support timely access to care, accurate reimbursement, and compliance with payer requirements. This role manages prior authorizations, admissions insurance, utilization review, credentialing, and payer relationships while helping improve revenue cycle efficiency and operational processes. The Revenue Utilization Manager is responsible for supervising, training, developing, and managing the performance of team members involved in insurance and utilization operations. Key Responsibilities Insurance & Authorization Management Oversee insurance verification, benefits confirmation, and prior authorization processes for Medicaid, Medicaid MCOs, and private/commercial insurance plans Ensure timely submission and tracking of authorizations •Work with clinical teams to support medical necessity documentation Monitor authorization and eligibility issues to reduce denials and delays Utilization Review & Denials Oversee utilization review activities and continued stay reviews Monitor denials and assist with appeals and corrective actions Track trends and identify opportunities to improve reimbursement and efficiency Credentialing & Payer Relations Manage provider credentialing and payer enrollment activities with Medicaid, Medicaid MCOs, and private/commercial insurance carriers Maintain provider and licensure records Serve as a liaison with Medicaid MCOs and private/commercial payers to resolve operational issues Team Leadership & Staff Management Supervise, train, mentor, and manage staff involved in insurance operations, utilization review, and authorization functions Provide onboarding, ongoing training, workflow oversight, and performance management for team members Establish accountability measures and support staff development to ensure operational efficiency and compliance Assist with staffing coordination, coverage planning, and process consistency across programs Reporting & Process Improvement Track and report key performance metrics related to authorizations, denials, and credentialing Train and support staff involved in insurance operations Standardize workflows and support system/process improvements across programs Qualifications and Education Requirements 3-5 years of experience in healthcare revenue cycle, utilization management, or insurance operations required Experience with Medicaid, Medicaid MCOs, private/commercial insurance, prior authorizations, and credentialing processes required Prior supervisory or management experience with responsibility for staff training, performance management, and team development strongly preferred Demonstrated ability to effectively lead, manage, and develop staff required Strong organizational, communication, and problem-solving skills required Experience in behavioral health or SUD services This position may require the use of a Company or personal vehicle. Candidates must have a valid driver's license. Full Circle Recovery Services is a

Drug-Free Workplace:

The Medical Marijuana Registration Card is not accepted for any employee.

Pay:

From $78,000.00 per year People with a criminal record are encouraged to apply

License/Certification:

Driver's License (Required)

Work Location:

In person