Full-Time
Utilization Review Manager
NeuroPsychiatric Hospitals
201-500 employees
Inpatient neuropsychiatric care for complex co-morbidities
No salary listed
Mishawaka, IN, USA
In Person
Travel between Doctors NeuroPsychiatric Hospital and Medical Behavioral Hospital of Mishawaka is required.
Bachelor's, Master's
 Medical, Clinical & Veterinary |
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- A bachelor's degree in Nursing, Social Work, Behavioral Health, or Counseling is required.
- A minimum of 5 years of utilization review experience in a hospital setting is required.
- A minimum of 3 years of experience as a supervisor and/or manager in a utilization review role is required.
- A master's degree is preferred.
- Five years of case management experience, including discharge planning in a hospital setting, is preferred.
- Registered Nurse, Licensed Practical Nurse, social work, or counselor state licensure is preferred.
- Case Management certification is preferred.
- Strong organizational, prioritization, problem-solving, and time-management skills are required.
- The ability to work independently and collaboratively with interdisciplinary teams is required.
- Knowledge of Utilization Management, Case Management, care management plans, and critical pathways is required.
- Knowledge of Centers for Medicare & Medicaid Services, regulatory, accreditation, and confidentiality requirements related to healthcare and utilization management is required.
- Strong clinical data analysis, research, and documentation skills are required.
- Proficiency with Microsoft Office, email, electronic health records, and computer systems is required.
- Lead and coordinate the hospital’s Utilization Review and Case Management program across designated facilities.
- Promote quality, cost-effective patient care through appropriate utilization of hospital resources, including review of medical necessity, level of care, length of stay, consultations, and discharge planning.
- Oversee clinical reviews of patient records and documentation to ensure medical necessity, severity of illness, and continued stay are supported by InterQual, Milliman, hospital, Centers for Medicare & Medicaid Services, and other applicable regulatory standards.
- Coordinate initial and concurrent reviews with payors, including precertifications, continued stay certifications, length-of-stay updates, reconsiderations, appeals, peer-to-peer reviews, external reviews, and state fair hearings as needed.
- Monitor patient cases throughout the entire episode of illness and identify barriers to care, discharge planning concerns, documentation gaps, and opportunities to improve outcomes and resource utilization.
- Collaborate with physicians, nurses, social workers, medical records, finance, and other interdisciplinary team members to achieve appropriate patient outcomes within established length-of-stay guidelines.
- Identify trends, problematic diagnosis-related groups, diagnoses, procedures, and utilization patterns and develop strategies to improve quality, resource utilization, reimbursement, and denial management.
- Partner with Medical Records, Finance, and physicians to promote accurate clinical documentation and coding and ensure appropriate reimbursement.
- Oversee admission and discharge audits and ensure the completeness, accuracy, validity, and reliability of patient discharge information.
- Ensure required provider certifications and documentation are completed and maintained in accordance with Centers for Medicare & Medicaid Services and regulatory requirements.
- Maintain accurate, timely, and real-time documentation in the electronic medical record and other applicable systems.
- Supervise, support, and educate Utilization Review and Case Management staff, including communicating updates to policies, procedures, regulatory requirements, and payor guidelines.
- Conduct interdisciplinary team meetings and facilitate communication among healthcare providers regarding utilization, case management, discharge planning, and patient care concerns.
- Develop, implement, and evaluate quality improvement and utilization management initiatives designed to improve patient outcomes and efficiently manage healthcare resources.
- Develop and monitor financial goals related to designated case types and utilize data and reporting to evaluate utilization, denials, reimbursement, and quality outcomes.
- Prepare and compile utilization review, denial management, case management, and other required patient and hospital reports.
- Maintain current knowledge of Centers for Medicare & Medicaid Services Conditions of Participation, federal and state regulations, accreditation standards, payor requirements, and emerging trends and research related to utilization management and case management.
- Serve as a resource and subject matter expert for utilization review, case management, resource utilization, and case mix reimbursement.
- Participate in internal and external committees, meetings, councils, workgroups, and performance improvement activities as appropriate.
- Maintain current knowledge of occurrence screening and risk management practices and support compliance with applicable policies and procedures.
- Adhere to NPH’s Corporate Compliance Policy, Code of Conduct, Conflict of Interest Policy, and all applicable hospital policies and procedures.
- Perform other duties as assigned.
- A master's degree is preferred.
- Five years of case management experience, including discharge planning in a hospital setting, is preferred.
- Registered Nurse, Licensed Practical Nurse, social work, or counselor state licensure is preferred.
- Case Management certification is preferred.
NeuroPsychiatric Hospitals runs inpatient facilities that treat patients with complex co-occurring psychiatric, neurological, and medical conditions. It uses an integrated care model with a multi-disciplinary team of physicians, psychiatrists, psychologists, nurses, social workers, and therapists to create individualized treatment plans. The campuses emphasize safety and can include sensory rooms to help regulate behavior for conditions like intellectual impairment, dementia, Parkinson’s disease, and Huntington’s disease. Patients are usually referred from emergency rooms or acute care settings, stay about 13–14 days to stabilize, and then return to their referring facility, with growth across Indiana, Arizona, and Texas backed by private equity.
Company Size
201-500
Company Stage
N/A
Total Funding
N/A
Headquarters
South Bend, Indiana
Founded
2005
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Simplify's Take
What believers are saying
- A 2026 Kalamazoo hiring push signals a brand-new hospital and continued expansion.
- 2026 job postings cite 32 openings, showing ongoing demand and operational scaling.
- NPH’s specialized niche matches underserved referrals from ERs, hospitals, and skilled nursing facilities.
What critics are saying
- WFYI’s 2025 investigation described repeated serious violations and hundreds of substantiated complaints.
- Indiana lawmakers proposed psychiatric-hospital oversight in January 2026 after scrutiny of NPH.
- A 2016 False Claims Act allegation said NPH maximized Medicare by holding patients 14 days.
What makes NeuroPsychiatric Hospitals unique
- NPH treats complex psychiatric-neurological-medical patients others reject, including dementia and Parkinson’s.
- Its interdisciplinary inpatient model spans psychiatrists, internal medicine, psychologists, therapists, and social workers.
- 2026 hiring pages show active operations across Indiana, Michigan, Texas, and Arizona.
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Benefits
Health Insurance
Dental Insurance
Vision Insurance
401(k) Company Match
Employee Assistance Program
Unlimited Paid Time Off
Paid Vacation
Employee Discounts
Tuition Reimbursement
Growth & Insights and Company News
6 month growth
↑ 17%1 year growth
↑ 17%2 year growth
↑ 17%Guru Nanak Dev University signs MoU with Neuropsychiatric Hospital. Guru Nanak Dev University opens new avenues for clinical training in psychology, Practical exposure is essential alongside classroom learning: Prof. Karamjeet Singh. Gurpreet Singh 5 dariya news. Amritsar, 19 jun 2026. Last updated on: jun 19, 2026, 17:16 IST. Under the guidance of Vice-Chancellor Prof. (Dr.) Karamjeet Singh Guru Nanak Dev University today signed a Memorandum of Understanding (MoU) with Bhatia Neuropsychiatric Hospital & De-Addiction Centre, Amritsar, to provide clinical training and internship opportunities to students enrolled in the Bachelor in Psychology (B.Psy.) programme and to strengthen mental health services through academic-clinical collaboration. The MoU was signed during a ceremony held at the Dean Academic Affairs' office in the presence of Dean Academic Affairs Prof. (Dr.) Harvinder Singh Saini, Registrar Prof. K.S. Chahal, Dean Student Welfare Prof. Satnam Singh Deol, Prof. Vasudha Sambyal, Director, Golden Jubilee Centre for Entrepreneurship and Innovation Head of the Department of Psychology Dr. Rupan Dhillon, and Director Dr. J. P. S. Bhatia of Bhatia Neuropsychiatric Hospital & De-Addiction Centre. Under the MoU, students of the B.Psy. programme will undergo practical and clinical training at Bhatia Neuropsychiatric Hospital under the supervision of qualified psychiatrists and psychologists. The collaboration will provide students with hands-on exposure to psychological assessment, counselling support, case observation, case formulation, psychoeducation, documentation, and other mental health services in a professional clinical setting. The first batch of B.Psy. students (2026-2030) will undertake their compulsory internship and practical training during the seventh and eighth semesters of the programme. The training will be conducted free of cost and in accordance with a mutually agreed schedule between the university and the hospital. Prof. (Dr.) Harvinder Singh Saini described the collaboration as an important step towards strengthening professional education in psychology and providing students with meaningful clinical exposure. He noted that such partnerships help bridge the gap between classroom learning and real-world mental health practice. Dr. Rupan Dhillon stated that the MoU would create valuable experiential learning opportunities for psychology students and contribute to the development of competent future mental health professionals. Director Dr. J. P. S. Bhatia welcomed the initiative and said that it was a long-awaited collaboration that he had been looking forward to for many years. He expressed confidence that the partnership would benefit both institutions while contributing significantly to mental health awareness, training, and service delivery in Punjab. The MoU shall remain valid for a period of five years and is expected to promote academic excellence, professional development, and community engagement in the field of mental health.
He said, "It has come to the attention of the National Association of University Students (NAUS) that an act of administrative impunity and corruption has allegedly been perpetrated by the Minister of State for Health and Social Welfare, Hon. Dr. Tunji Alausa (now Hon. Minister of Education), in the appointment of the new Chief Medical Director for Neuropsychiatric Hospital, New Heaven Enugu."
Dr. Ngozichukwu Unaogu, despite not meeting up with the minimum required score was appointed Chief Medical Officer of the Neuropsychiatric Hospital, New Heaven, Enugu.