MAKE A DIFFERENCE

We’re looking for a detail-oriented Access & Utilization Manager to ensure members receive timely, appropriate care funded through Medicaid MCOs and private insurance. This role partners closely with clinical teams and payers to support authorizations, compliance, and quality outcomes.

Key Responsibilities:

• Review clinical information for intake, reauthorization, and discharge planning


• Verify Medicaid eligibility and maintain accurate funding records


• Secure prior authorizations (MCOs, private insurance, private pay) and identify co-pays


• Enter and manage funding data in MyEvolv; escalate denials promptly


• Support staff in determining medical necessity, level of care, and length of stay


• Monitor utilization trends (e.g., readmissions, high-cost cases) and support improvement efforts


• Track Single Case Agreements for PMIC clients and B3 for QRTP


• Escalate complex/high-risk cases and assist with resolution


• Ensure compliance with documentation, audits, and contractual requirements


• Collaborate with internal teams and external partners to improve care coordination


• Set up and process Client Participation Fee with guardians
  

  Who are we?

  
  
  

  
  
  At Four Oaks, we believe that every child needs the opportunity to succeed. It’s more than our mission – it’s the passion that permeates everything we do. Four Oaks has grown to become one of the state’s largest agencies devoted to child welfare, education, juvenile justice and behavioral health. We recognize that children and families come to us from a variety of circumstances, which makes it important for us to reach kids and families where they are right now. For that reason, we provide prevention, intervention and treatment programs and services.

  
  
  

   

  
  
  

  Why Work here?

  
  
  

  We are more than a team, we are family!   Four Oaks understands the importance of supporting and treating one another as if they were our own family members.  We believe in maintaining a healthy work/life balance while providing career paths for everyone.  Our organization flourishes in an environment of equal opportunity and fair treatment for all.  The effects of diversity and inclusion have created an atmosphere of positivity which connects us to the customers we serve.  As a valued team member, you are eligible for:

  
  


• Medical, dental & vision insurance


• 401k Retirement plan


• Growth & Advancement opportunities


• Competitive wages


• Excellent paid leave time package


• 7 paid holidays  


• Business casual work environment


• Educational discounts


• Fitness Center Discounts