Admissions Utilization Management Coordinator, Crisis

MONARCH•Concord, NC

About The Position

Serves as the initial point of contact for all individuals in the community interested in Monarch's Crisis Services. Effectively communicate with referral sources. Enter screening and referral information in the electronic health record system. Generate initial referral information about the youth and facilitate completion of supporting documentation. Present summary to the Interdisciplinary team for determination decision. Follow up with referral source on outcome of determination decision. Completes prior authorization within identified timeframes. Assembles information to establish medical necessity using clinical information contained in the electronic health record system to justify initial and continued service for the youth at the site to payors as required. Makes recommendations to the Interdisciplinary team if services are not likely to be authorized prior to end date. Attend and actively participate in meetings and training as required. Complete documentation in EHR as required. Maintain current licensure and certification in all agencies, state, and federal training requirements. Completes record audits for adherence to Service Definitions, UM Guidelines, DHSR and Accrediting bodies. Demonstrate knowledge of and comply with all agency policies and procedures, as well as state and federal statutes and regulations related to specific program areas. Demonstrate knowledge of emergency procedures and assist in crisis situations. Participate in on call and afterhours coverage, including weekends and holidays as needed. Complete all other relevant responsibilities as assigned by the supervisor. Driving and travel may be required.

Requirements

Minimum of a Bachelor Degree (dependent upon experience)
Qualified Professional (QP) - Monarch-DSM
Experience working with children/adolescents with a mental health diagnosis and/or substance use disorder | 2-4 years (Dependent Upon Education - see Job Description) | Required
Bachelor degree (non Human Services) with 4 years Full time OR 8 years Part time applicable experience required
Bachelor degree (Human Services) with 2 years Full time OR 4 years Part time applicable experience required
Master degree (Human Services) with 1 year Full time OR 2 years Part time applicable experience required

Responsibilities

Serves as the initial point of contact for all individuals in the community interested in Monarch's Crisis Services.
Effectively communicate with referral sources.
Enter screening and referral information in the electronic health record system.
Generate initial referral information about the youth and facilitate completion of supporting documentation.
Present summary to the Interdisciplinary team for determination decision.
Follow up with referral source on outcome of determination decision.
Completes prior authorization within identified timeframes.
Assembles information to establish medical necessity using clinical information contained in the electronic health record system to justify initial and continued service for the youth at the site to payors as required.
Makes recommendations to the Interdisciplinary team if services are not likely to be authorized prior to end date.
Attend and actively participate in meetings and training as required.
Complete documentation in EHR as required.
Maintain current licensure and certification in all agencies, state, and federal training requirements.
Completes record audits for adherence to Service Definitions, UM Guidelines, DHSR and Accrediting bodies.
Demonstrate knowledge of and comply with all agency policies and procedures, as well as state and federal statutes and regulations related to specific program areas.
Demonstrate knowledge of emergency procedures and assist in crisis situations.
Participate in on call and afterhours coverage, including weekends and holidays as needed.
Complete all other relevant responsibilities as assigned by the supervisor.
Driving and travel may be required.