Utilization Manager

Job Title: Utilization Manager

Job Status: Full-Time or Part-Time

Accountable to: Chief Executive Officer

Purpose:

The Utilization Manager (UM) is responsible for the authorization, quality and organization of services providing to clients. These standards are met by analyzing documents, charts and files, systemizing operational procedures and monitoring the delivery of services. The Utilization Manager ensures all clients are provided complete services based on comprehensive assessments, a proper diagnosis, and the careful development of individual service plans. The management and security of all medical records are essential to UM responsibilities.

Minimum Qualifications: Professionally licensed as a LCSW, LPC, LMFT or RN, or possession of a master’s degree from an accredited college or university in Psychology, Community Counseling, Social Work, Criminology or related field and 2 years of experience providing community or residential counseling. Person must be credentialed and able to provide at least therapeutic services to eligible clients. The candidate for this position must have experience in conducting Behavioral Health Assessments, developing “SMART” Treatment Plans and writing in the B.I.R.P. format. Proficiency is in Microsoft Word, Excel and Outlook is a plus.

Duties to include:

1. Conduct quality examination of all documented services to ensure proper treatment is being provided to each client. The reviewing of medical and clinical records includes, but is not limited to Assessments, Psych Evaluations, Individual Service Plans and Progress Notes. Conclude with evidence of the reviews by writing and/or signing Orders for Services to authorize clients for treatment as needed.

2. Review notes on a weekly basis to ensure accurate service codes, units and clinical rational for service rendered and assist individual staff in improving their treatment plan and progress note writing skills as needed.

3. Conduct quality assurance on the Agency’s assessment/treatment planning tool to assure it meets the external auditing Agency requirements.

4. Assist in maintaining the department files, records and charts. Conduct scheduled and systemized weekly chart audits and monthly billing audits.

5. Process and submit cases for authorization, reauthorization and discharges. Input and review MICP data as needed to ensure the timely authorization of cases.

6. Develop “SMART” treatment plans

7. Maintain census to include start dates and upcoming expiration dates for each client.

8. Provide clinical services to authorized clients as needed or directed by conducting Behavioral Health Assessments, Treatment Plans, Groups, Counseling Services and Skills Training.

9. Provide direction to Assessors in regard to assigned bio-psychosocial assessments assigned as needed.

10. Ensure that Assessors are completing assessments within 72 hours of assignment and providing feedback in regard to the process of assignments.

11. Train staff on how to complete Agency documentation according to accreditation policies and funding policies, i.e., assessments, treatment planning, progress notes when needed.

12. Input authorizations for Adult and Child/Adolescent CORE in the system to maintain units for each client.

13. Email authorization updates to all staff to prevent excessive billing and adherence to authorization

14. Answer incoming questions related to authorizations, units, reauthorizations, etc.

15. Communicate with Medicaid and other insurance companies regarding authorization approval and provide additional information, if necessary

16. Prior authorizations for inclusion in the chart

17. Maintain a spreadsheet with authorization start and end dates.

Job Type: Full-time

Pay: $18.00 - $43.00 per hour

Education:

• Bachelor's (Required)

Experience:

• Utilization review: 1 year (Preferred)

License/Certification:

• RN (Preferred)

Work Location: In person

Salary : $18 - $43