Insurance Utilization Review Jobs in Missouri (NOW HIRING)

UR Manager

Full Time

St. Louis, MO, US

Join Us to Build Healing and Hope Together!

As leaders in children’s mental health and wellness, St. Louis Children’s and KVC Health Systems Youth Mental Health Care have partnered to create one of the nation’s most innovative and transformative youth mental health and wellness campuses. The partnership includes a 77-bed acute care hospital and outpatient programs. Located on the KVC Missouri Children’s Mental Wellness Campus conveniently located in Webster Groves, Missouri, the peaceful environment and broad continuum of care allow children and families to access the appropriate level of treatment throughout their healing experience. The new campus is slated to open in late 2026. Learn more at stlouischildrenskvc.org. Join us and be a part of this journey of healing and hope for thousands of children and teens.

Job Summary

The Utilization Review department carries with it the responsibility of managing those aspects of a patient stay that relates to the initial, concurrent and discharge interface with health plans. The Utilization Review Manager provides engaging and inclusive leadership to the UR department, who will be in frequent contact with health plans, providing clinical information developed by the treatment team and staff working with a diverse group of patients and families. This role requires high attention to detail at the very fast pace of short-term hospitalization. The role is part of the treatment team and will partner with the Admissions department, physicians, nurses, and therapists to ensure timely, accurate and complete assessments are performed on KVC’s patients and make appropriate referral for placement and services based on the assessments.

Education:

Bachelor’s degree in human service field (i.e. social work, education, sociology, psychology, counseling, human relations) or criminal justice.

Licensure/Certification:

Valid driver’s license and auto insurance.

Experience:

A minimum of two years of experience in Utilization Review, and at least one year of experience in a leadership role.

Skills:

Requires intermediate skill level with Microsoft Office, including Word, Excel, and Outlook email.

Preferred Experience/Skills:

Bachelor’s degree in social work and licensure with the Missouri Division of Professional Registration (MOPRO) preferred.

Experience working with economically disadvantaged, vulnerable or at-risk youth and/or young adults preferred.

Major Duties:

• Practice conduct that displays respect for all KVC colleagues and community stakeholders regardless of age, gender identity, sexual orientation, race, religion, ethnicity, or veteran status

• Supervises the Utilization Review Specialist to ensure completion of tasks, job description and compliance with KVC’s policies and procedures
• Completes all necessary reports on utilization review data
• Maintains strictest confidentiality about child/youth/family information
• Frequent telephonic interface with health plans
• Maintain accurate recording of information andensurethat this is provided to others in an accurate fashion
• Gathers data, compiles information, and completely and accurately (including grammar and spelling) enters information into the data management system
• Understandsand remainsup to dateon JIAC and KVC policies and procedures, KVC programs and services,and outside community agencies
• Communicates effectively and respectfully both orally and in writing with children/youth, family members, staff, other service agencies, and the public; uses strong active listening skills
• Possesses strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community
• Responsible for achieving and maintaining proficiency in the utilization of KVC information systems, including but not limited to Avatar, Citrix, and UltiPro
• Accountable to know and enforce the staff handbook as well as KVC Hospitals, Inc. policies and procedures
• Manages Utilization Review employees, including oversight or responsibilities, approval of hours worked and PTO, compliance with KVC and accrediting body policies and procedures, fairly executing progressive disciplinary action and performance evaluations
• Regularly attends treatment team and staff meeting, or reviews minutes of meetings to remain uptodate
• Discuss and/or obtain advance approval from Supervisor to attend training, submit check requests, vacation requests and reimbursement requests
• Attend staff conferences and in-service training as required or needed

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand, walk, talk, or hear, and taste or smell. The employee frequently is required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The employee is occasionally required to sit for intermittent amounts of time. The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds, and occasionally lift and/or move up to 75 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Benefits & More

Employee benefits and culture fall under the KVC Health Systems umbrella. KVC is a family of private, nonprofit organizations that strengthen families, prevent child abuse and neglect, and help people achieve mental health wellness. Through our broad continuum of care, we are proud to be a national leader in mental health, child welfare, and health and human services transformation.

At KVC, we offer a positive, supportive workplace where each person can do work they love. In fact, we’re so proud of our culture that we see it as our top competitive advantage in the health and human services field. Based on the voice of our employees, KVC has an incredible 83 Work Wellbeing score on Indeed, a rating so high and rare that it places KVC among the top 1% of employers nationally. KVC was also named #15 on Glassdoor’s Best-Led Companies 2025 list, a recognition achieved entirely based on anonymous employee reviews. In addition to being mission-driven, we offer employees an unparalleled level of flexibility, wellbeing, learning, inclusion, recognition, and rewards.