JOB TITLE:
Utilization Manager
SUMMARY:
The Utilization Manager is responsible for overseeing and coordinating all utilization management activities within the OASAS 820 program. This role ensures that services are delivered in accordance with regulations, medical necessity criteria, and organizational standards. The Utilization Manager works closely with clinical, medical, and administrative teams to optimize service delivery, support appropriate levels of care, and maintain compliance with all documentation and reporting requirements. The Utilization manager will be reporting to the Clinical director of residential services. This position reports to the Billing Manager.
REPORTING RELATIONSHIP:
This position reports to the Billing Manager
SCHEDULE:
10AM - 6PM, flexibility in schedule to include some evenings and weekends based on program need.
LOCATION: Corona, Queens NY
POSITION TYPE:
Fulltime - requires flexibility to cover shifts in the event of staffing shortages or emergencies
ESSENTIAL DUTIES/RESPONSIBILITIES:
- Monitor and review all admissions, continued stays, and discharges to ensure alignment with OASAS Part 820 requirements and medical necessity.
- Conduct regular utilization reviews to ensure appropriate level‑of‑care placement (Stabilization, Rehabilitation, and Reintegration).
- Ensure timely completion and submission of required documentation, including LOCADTR assessments, treatment plans, and progress updates.
- Maintain compliance with OASAS, Medicaid, and managed care organization (MCO) guidelines.
- Prepare for and participate in audits, quality reviews, and regulatory inspections.
- Serve as the primary liaison with MCOs, OASAS representatives, and external partners regarding authorization, continued stay requests, and service utilization.
- Collaborate with clinical leadership to identify barriers to care and support timely transitions between levels of care.
- Communicate utilization trends, concerns, and recommendations to program leadership.
- Track and analyze utilization data, including census, length of stay, authorization status, and service patterns.
- Generate regular reports for internal leadership and regulatory bodies as required.
- Identify trends and recommend improvements to enhance service efficiency and outcomes.
- Participate in quality improvement initiatives related to documentation, service delivery, and regulatory compliance.
- Provide training and support to staff on utilization requirements, documentation standards, and best practices.
QUALIFICATIONS:
- Master’s degree in Social Work, Psychology, Health Administration, or related field
- Minimum 2–3 years of experience in substance use disorder treatment, behavioral health, or utilization management.
- Knowledge of OASAS Part 820 regulations and LOCADTR criteria.
- Experience working with Medicaid and managed care organizations.
- CASAC, LMSW, LMHC, or related credential.
- Experience in residential or stabilization-level SUD services.
- Familiarity with electronic health records (EHR) and utilization management platforms.
- Strong organizational, communication, and analytical skills
OTHER SKILLS/ABILITIES:
- Must have strong interpersonal skills to support leadership, management, negotiation and problem-solving functions of this role.
- Friendly, courteous, service-orientated, professional, outgoing, and client service oriented.
- Outstanding detail oriented skills while maintaining an extremely positive attitude.
- Excellent verbal and written communication skills; draft clear and concise text for producing documents, evaluations and other reports and policies and procedures of high professional quality;
- Excellent time management, organizational, and computer software skills.
- Must be able to work independently and productively with minimum supervision.
- Team play with a “can do” attitude that can work in a fast paced environment.
- Ability to establish and maintain a professional atmosphere for employees.
- Performs job tasks in a manner that does not result in negative audit reviews.
BENEFITS:
15 Vacation days Annually
12 Sick Days
Floating Holiday 1 annually
401K retirement plan with 3% match after 90 days of employment
Medical Benefits after 30 days of employment with Cigna
Dental/Vision eligible after 90 days of employment
Access to Gym/Weight Room
Access to Boxing Ring
Short Term Disability
Life, Accidental Insurance available through Aflac
Transit Chek for commuting expenses
Legal Shield for legal services
Public Service Loan Forgiveness (PSLF) participants
Are you passionate about making a meaningful impact in your community?
Join Elmcor Youth & Adult Activities as a Director of Operations and lead the oversight of essential programs and services that support individuals and families in need. This role provides the opportunity to guide daily operations, strengthen service delivery, and ensure programs are delivered with a focus on safety, stability, compliance, and excellence.
If you are a strategic and experienced leader committed to operational effectiveness and making a meaningful community impact, we encourage you to apply today and take the next step in a purpose-driven career.
