Inpatient Utilization Management Specialist
About The Position
The Inpatient Utilization Management Specialist participates in daily treatment team meetings in Crisis Services programs to identify new patients and determine their financial income information, behavioral health and substance abuse insurance coverage, and prescription medication insurance coverage. The specialist attempts to obtain insurance cards or other documentation from patients or their family or friends when intake staff cannot obtain it at admission. The role verifies benefit coverage for identified insurance plans and communicates patient responsibilities. It provides timely and accurate clinical information to third-party payers to support coverage for inpatient treatment services, and gives nursing and administrative staff feedback about documentation needs, payment denials, and doctor-to-doctor consultations needed to assure treatment coverage. The specialist drafts insurance appeals as needed and assists with ACSU Daily Census reporting required by CFBHN. This is a part-time position based in Punta Gorda, Florida. The scheduled workdays are Saturday and Sunday, on the day shift. Travel is negligible. The stated hourly salary range is $16.50 to $18.50, with a $500 sign-on bonus.
Requirements
- High school diploma or equivalent.
- Ability to pass a Level II background clearance and drug test.
Nice To Haves
- Minimum of two years' experience in the behavioral health field.
- Familiarity with health insurance, managed care organizations, third-party payers, and ASAM level-of-care criteria.
- Utilization management experience in a health-related field.
Responsibilities
- Participate in daily treatment team meetings in Crisis Services programs to identify new patients and communicate with them about income information and insurance coverage.
- Attempt to obtain insurance cards or other documentation from patients or their family or friends if intake staff cannot obtain them at admission.
- Verify benefit coverage for identified insurance plans and communicate patient responsibilities.
- Provide timely and accurate clinical information to third-party payers to support coverage for inpatient treatment services.
- Provide nursing and administrative staff with feedback about documentation needs, treatment payment denials, and the need for doctor-to-doctor consultation to assure coverage.
- Draft insurance appeals as needed.
- Assist with ACSU Daily Census reporting required by CFBHN.
Benefits
- Dental, vision, health, and life insurance (listed for full-time employees).
- Employee Assistance Program (EAP).
- Employer-sponsored contribution to a Health Savings Account (HSA), with a qualifying insurance plan.
- Paid Time Off (PTO).
- 11 paid holidays.
- 403(b) retirement plan with a 9% employer contribution for eligible employees.
- Tuition reimbursement.
- Public Service Loan Forgiveness (PSLF) eligibility.
- Health Resources and Services Administration (HRSA) loan repayment eligibility for qualifying staff.
- $500 sign-on bonus.
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What This Job Offers
Job Type
Part-time
Education Level
High school or GED
