Utilization Management Specialist - Substance Use Disorder

Hegira Health, Inc. (HHI), a private non-profit corporation, is one of the largest freestanding behavioral healthcare agencies in the area. HHI, accredited by the Joint Commission and licensed by the State of Michigan, provides a broad array of mental health and substance abuse treatment and prevention services to individuals of all ages.

Oakdale Recovery Center (ORC) - provides withdrawal management and short-term residential treatment services to adults with substance use disorders, many whom have mental health disorders as well. Average LOS is 3 days for WD and 14 days for residential treatment. Hegira Health, Inc.

Schedule: Sunday through Thursday 9am-5:30pm

Utilization Management Specialist Education/ Experience:

• High school diploma
• Experience with admissions and authorizations
• EHR experience preferred
• Proficiency in Microsoft Office Word, Excel and Outlook

Utilization Management Specialist Primary Responsibilities (summary of):

• Complete admissions and authorizations within payor electronic records for all consumers being admitted to another level of care within Withdrawal Management and Residential in accordance with specified time frames.
• Complete required reauthorizations for service payment at least 24 hours in advance of expiration.
• Complete discharge within payor electronic records as required and within specified timeframes.
• Train and or assist in the training of new clinical staff regarding authorizations.
• Assure and or assist in the assurance that new clinical operations related to authorizations are implemented as planned/required.
• Monitor admissions and authorizations for Withdrawal Management and Residential within payor electronic records and inform Therapists of authorization issues, such as pending requests, denied requests, and missing information. Follow up with Therapists on all identified authorization issues to ensure resolution within funding source identified timelines.
• Monitor admissions daily to Withdrawal Management and Residential within all funding sources EHRs to ensure admission and authorization documentation is completed accurately and within identified timelines.
• Ensure all automatic authorizations within payor electronic records have been submitted and if not, inform assessing therapist to complete required admission and authorizations.
• Collaborate with Billing Department at Administration to ensure all services are authorized and able to be billed.

Job Type: Full-time

Pay: $17.00 - $20.00 per hour

Expected hours: 40 per week

Benefits:

• 403(b)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Medical Specialty:

• Addiction Medicine
• Psychiatry

Schedule:

• 8 hour shift

Application Question(s):

• Are you proficient using Microsoft including Word, Excel and Outlook?
• Do you have EHR experience? Which EHR systems have you used?
• Can you work Sunday through Thursday 9am-5:30pm?

Education:

• High school or equivalent (Required)

Experience:

• admissions and authorizations: 1 year (Preferred)

Work Location: In person

Salary : $17 - $20