Admissions Utilization Management Coordinator, Crisis

Monarch•Concord, NC

About The Position

Make a Difference in Someone’s Life! At Monarch, we work together to provide life-changing care in communities across North Carolina and Rhode Island. As a team, we provide hope, promote wellness, and empower individuals and families impacted by mental illness, substance use disorders, intellectual and developmental disabilities, and traumatic brain injury. You Belong at Monarch You deserve a positive and encouraging work environment - a place where you can do your best work and grow as a professional. That is just what you’ll find at Monarch. Here, we care for people, including our team members. We offer a comprehensive, competitive benefits package that supports full-time and part-time team members and their families. More than just a job, this opportunity with Monarch will give you room to spread your wings and grow because we believe in promoting from within and developing future leaders. Job Highlights: A Qualified Professional (10A NCAC 27G .0104) must have one of the following: 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 This Opportunity: The primary responsibility of this position will be to review and summarize referrals for admission to Monarch's Crisis Services, including ensuring authorizations are in place prior and during the length of stay.

Requirements

Minimum of a Bachelor Degree (dependent upon experience) (Required)
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

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.