Inpatient Utilization Management Specialist

CHARLOTTE BEHAVIORAL HEALTH CARE INC • Punta Gorda, FL

1d • Onsite

About The Position

This role involves participating in daily treatment team meetings in Crisis Services programs to identify new patients and gather financial and insurance information. The specialist is responsible for verifying insurance benefits, communicating responsibilities to patients, and ensuring updated insurance information is shared with staff. Key duties include coordinating with nursing for medication coverage, providing clinical information to third-party payers for inpatient treatment coverage, and offering feedback to staff regarding documentation and payment denials. The specialist also obtains and tracks authorizations, provides clinical data for reviews, drafts insurance appeals, assists with ACSU Daily Census reporting, records patient insurance status, and provides regular reports to administration. The role requires coordination with a full-time utilization management specialist and providing coverage when needed.

Requirements

• High school diploma or equivalent.
• Ability to pass a level II Background clearance and drug test.
• Strong knowledge of UM principles and practices.
• Proficiency in behavioral health terminology and documentation.
• Proficiency in using electronic medical record (EMR).
• Must maintain high standards of ethical and professional conduct, while adhering to agency policies and procedures.
• Ability to work in an environment with frequent interruptions.
• Ability to work independently and as part of a team, in collaboration with other community partners.
• Ability to manage stressful situations and display appropriate work demeanor and boundaries.
• Ability to demonstrate excellent customer service.
• Effective communication and interpersonal skills.

Nice To Haves

• Minimum of two (2) years’ experience in behavioral health field.
• Familiarity with health insurance, managed care organizations, third party payers and ASAM level of care criteria.
• Preferred UM experience in a health related field.

Responsibilities

• Participate in daily treatment team meetings in Crisis Services programs for the purpose of identifying new patients and communicating with them to determine financial income information, behavioral health and Substance Abuse insurance coverage as well as prescription medication insurance coverage.
• Attempt to obtain copies of insurance cards or other documentation from the patient or patient’s family/friends should intake staff be unable to procure at admission.
• Verify benefit coverage for all identified insurance plans, and communicate responsibilities to patients.
• Assure that updated insurance information is communicated via email to nursing and administrative staff.
• Coordinate with nursing staff as needed to determine insurance coverage for medications ordered while the patient remains on the unit.
• Provide timely and accurate clinical information to third party payers as needed to assure coverage for inpatient treatment services.
• Provide feedback to nursing and administrative staff regarding need for documentation, denial of payment for patient treatment, or need for doctor-to-doctor consultation to assure coverage of treatment.
• Responsible for obtaining and tracking authorizations/pre-authorizations for treatment and providing all necessary information to ensure timely payment of insurance claims (including State Authorization requirements).
• Provide all clinical data requested by insurance companies for pre–authorizations and all reviews.
• Draft insurance appeals as needed.
• Responsible to assist in the reporting of ACSU Daily Census reporting, required by CFBHN.
• Record patient insurance status, authorizations, authorization updates, into all mandated logs and reporting instruments.
• Provide regular reports to administration regarding monies collected and insurance information.
• Coordinate and communicate with the full time utilization management specialist to ensure continuity of authorizations.
• Provide coverage to inpatient UM positions when needed.

Benefits

• Sign-on Bonus: $500
• Full-time Dental, vision, health, and life insurance.
• Employee Assistance Program (EAP).
• Employer sponsored contribution to Health Savings Account (HSA), with qualifying insurance plan.
• Paid Time Off (PTO).
• 11 paid holidays.
• 403b Retirement Plan, with 9% employer contribution for those who meet eligibility requirements.
• Tuition reimbursement, Public Service Loan Forgiveness (PSLF) eligible, and Health Resources and Services Administration (HRSA) loan repayment eligible for qualifying staff.

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees