UTILIZATION COORDINATOR

UHS • Bloomington, IN

84d

About The Position

The Utilization Management Specialist is responsible for executing the UM function, which includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients. Oversees the response to requests for services and interfaces with managed care organizations, external reviewers, and other payers. Assures that good customer service practices are utilized. Maintains denials and appeals in Midas and reviews the progress of all appeal activity.

Requirements

• Diploma required
• Two (3) years direct clinical experience in a psychiatric or mental health treatment setting preferred.
• Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.

Nice To Haves

• Bachelor Degree or Masters in Nursing or Social Work preferred.
• Valid Indiana Registered Nursing or LCSW preferred

Responsibilities

• Executing the UM function
• Implementation of case management scenarios
• Consulting with all services to ensure the provision of an effective treatment plan for all patients
• Overseeing the response to requests for services
• Interfaces with managed care organizations, external reviewers, and other payers
• Assuring good customer service practices
• Maintaining denials and appeals in Midas
• Reviews the progress of all appeal activity

What This Job Offers

• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees