[Hiring] Utilization Management Specialist @Paradigm Treatment Centers

Role Description

The Utilization Management Specialist is responsible for directing and overseeing the reporting of utilization statistics and trends, consulting with all services to ensure the provision of an effective treatment plan for all patients, and interfaces with managed care organizations, external reviewers, and other payers.

Responsibilities

• Advises clinical team of documentation necessary to successfully advocate for admission and continued stay at the most appropriate level of care.
• Utilize clinical information and knowledge of Behavioral & Mental Health Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
• Collaborates with the Admissions and Billing departments for the purpose of supporting and improving the commercial insurance authorization process.
• Maintain logs and databases for utilization management, fiscal management, care coordination activities, and performance improvement measures.
• Conduct prospective, concurrent, and retrospective reviews as required by networks, utilizing telephonic information, medical records, and/or faxed medical information and establish single cases as necessary.

Qualifications

• Previous experience with Utilization Review.
• Previous experience within the field of mental health or behavioral health.

Requirements

• Salary Range: $31.25 — $31.25 USD

Benefits

• Comprehensive benefits package: medical, dental, and vision.
• 401k with 4% match.
• Paid Time Off Programs including vacation, holidays, and illness.
• For Direct Care roles: Chef made meals onsite.
• Professional trainings provided for development; continuing education assistance for clinicians.
• Supportive clinical supervision and professional development.