Utilization Management Coordinator

What You'll Do:

 

• Works with all payers to secure authorization for inpatient stays for all individuals admitted to Inpatient or COE Unit.
• Performs utilization review in accordance with all Payor requirements, State Regulations, and Joint Commission Standards. Ensures all payer utilization management staff receive needed daily information to perform their reviews.
• Obtain authorizations for previously identified procedures where required.
• Reviews medical records and evaluates patient progress towards discharge. Performs continuing review on medical records and identification and need for on-going inpatient services. Obtains necessary medical reports, treatment plans and validates BHMP’s progress notes/evaluations for appropriate justifications of continued stay.
• Documents review information as required by State and Payor regulations. Communicates results to applicable payor sources: including requests to BHMP’s for expedited follow-up to all payer UM staff.
• Complies with regulation changes affecting utilization management. Facilitates educational programs and advises physicians and other departments of regulations affecting utilization management.
• Performs all other duties as assigned.

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, WA

• High School Diploma or equivalent 
• At least 2 years of behavioral health experience
• Expertise in Utilization Management responsibilities, tasks and functions, and/or Clinical auditing experience
• The Company has a mandatory vaccination policy. All successful applicants must be fully vaccinated, including showing proper documentation, or otherwise be exempt pursuant to the Company’s exemption process prior to their start date as a condition of employment

• Bachelor's degree in Nursing, behavioral health, social work, medical coding, or related field
• Previous clinician (Social Work) experience
• Licensed MSW
• Strong organizational, documentation, and data-entry skills
• Excellent communication, customer service abilities
• Familiarity with Medicare, Medicaid, and commercial insurance requirements
• Proficient 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

• Employees (and their families) are offered comprehensive health insurance, including Medical, Dental, Vision, Accident, Critical Illness, and Hospital Indemnity
• CHS pays for Basic Life, AD&D, Short and Long-Term Disability
• Voluntary Life insurance option for employees and their families
• Health Savings Accounts (with $1,000 to $2,000 employer contribution depending on plan)
• Flexible Spending Accounts (health care and dependent care)
• 401k company match after 6 months (50% of deferrals up to 6% of compensation)
• Generous PTO starting at 160 hours accrued annually and 12 recognized company holidays
• Company‑paid parental leave available to eligible employees

• Employee Assistance Program to help with confidential emotional support, work life solutions, financial solutions, legal assistance, or online support
• After 90 days, you are auto enrolled in the 401k Plan 

Connections Health Solutions is proud to be a Second Chance Employer.

EEO Statement

Connections Health Solutions is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. We are committed to creating an inclusive and welcoming environment for all employees and applicants.