Utilization Management Coordinator
New
C
Connections Health SolutionsBehavioral Health
This is a fully remote position in these states: AL, AR, AZ, CA, CO, CT, DC, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MT, NC, NJ, OH, OR, PA, RI, SC, TN, TX, UT, VA, WAFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- At least 2 years of behavioral health experience
- Required Skills
- Microsoft ExcelDocumentationData entry
Requirements
- High School Diploma or equivalent.
- At least 2 years of behavioral health experience.
- Expertise in Utilization Management responsibilities, tasks and functions.
- Clinical auditing experience.
- Strong organizational, documentation, and data-entry skills.
- Excellent communication and customer service abilities.
- Proficiency in Microsoft Excel for tracking, reporting, and record management.
- Knowledge of ADHS/DBHS and RBHA Policies and Procedures relative to Utilization Management.
- Previous experience obtaining authorization from third parties.
Responsibilities
- Work with all payers to secure authorization for inpatient stays for all individuals admitted to Inpatient or COE Unit.
- Perform utilization review in accordance with all Payor requirements, State Regulations, and Joint Commission Standards.
- Obtain authorizations for previously identified procedures where required.
- Review medical records and evaluate patient progress towards discharge.
- Perform continuing review on medical records and identification and need for on-going inpatient services.
- Obtain necessary medical reports, treatment plans and validates BHMP’s progress notes/evaluations for appropriate justifications of continued stay.
- Document review information as required by State and Payor regulations.
- Communicate results to applicable payor sources including requests to BHMP’s for expedited follow-up.
- Facilitate educational programs and advise physicians and other departments of regulations affecting utilization management.
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