Clinical Utilization Manager
About The Position
Job Summary: The Utilization Manager leads a team that is responsible for all authorization processes. Oversee timely reviews, denial prevention and appeal management. The Utilization Manager will provide developmental training to clinical teams to assist with peer-to-peer reviews and utilization expectations. Duties and Responsibilities: Supervise staff to coordinate/manage all authorization processes. Track authorization pends and provide feedback to clinical staff and supervisors regarding utilization trends. Assist with denials and provide assistance to clinical staff and supervisors regarding the appeal process and utilization expectations. Provide training to clinical staff to improve authorization documentation Assist with the development of technical plans which would enable the agency to prepare for possible changes in managed care. Provide technical assistance and advice in developing, implementing, and improving clinical programs. Customer Support: Responding to phone calls and emails from Clinical Staff Distribute monthly Clinical Audits System Error Coordination: Analyze and problem solve issues with current and planned systems as they relate to the integration and management of client data Service Corrections Duplicate Client records in EHR Documentation Errors Implement State Reporting Changes related to authorization in the EHR system Reports Prepared and Distributed to the appropriate staff AD Hoc Reporting EHR system automated reporting
Requirements
- Master’s degree in Social Work or Counseling
- Licensed Professional Counselor (LPC) or equivalent
- At least 2 years of clinical experience in behavioral health
- Strong Clinical judgment, communication, interpersonal, and organizational skills
- Experience in a clinical setting
- Experience with healthcare information systems and software
- Previous management or supervisory experience
- Proficiency in data analysis and report generation
- Excellent analytical and problem-solving skills, with the ability to interpret complex healthcare data and identify trends and patterns.
- Exceptional communication and interpersonal skills, with the ability to liaise effectively with diverse stakeholders, including medical staff, insurance providers, and regulatory agencies.
- Proficient computer skills, including experience with electronic health record systems and Microsoft products.
- Demonstrated leadership abilities, with the capacity to motivate and inspire a team towards achieving organizational goals.
- Strong attention to detail and ability to adhere to strict confidentiality guidelines.
- Demonstrated ability to work independently and manage multiple priorities in a fast-paced environment.
Responsibilities
- Supervise staff to coordinate/manage all authorization processes.
- Track authorization pends and provide feedback to clinical staff and supervisors regarding utilization trends.
- Assist with denials and provide assistance to clinical staff and supervisors regarding the appeal process and utilization expectations.
- Provide training to clinical staff to improve authorization documentation
- Assist with the development of technical plans which would enable the agency to prepare for possible changes in managed care.
- Provide technical assistance and advice in developing, implementing, and improving clinical programs.
- Responding to phone calls and emails from Clinical Staff
- Distribute monthly Clinical Audits
- Analyze and problem solve issues with current and planned systems as they relate to the integration and management of client data
- Service Corrections
- Duplicate Client records in EHR
- Documentation Errors
- Implement State Reporting Changes related to authorization in the EHR system
- Reports Prepared and Distributed to the appropriate staff
- AD Hoc Reporting
- EHR system automated reporting
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What This Job Offers
Job Type
Full-time
Career Level
Manager
