Utilization Management Clinical Specialist (B
About The Position
Want to make an impact? I Am Boundless is hiring for a Utilization Management (UM) Clinical Specialist! Boundless is a non-profit organization specializing in assisting individuals with I/DD and has been serving Ohio for over 40 years. At I Am Boundless, we’re on a mission to build a world that realizes the boundless potential of all people. Join our team, which shares a common passion and purpose in empowering our community. As a Utilization Management Clinical Specialist, you’ll play a meaningful role in supporting the organization’s clinical utilization management processes to ensure services are delivered in accordance with medical necessity, regulatory requirements, and payer authorization standards. This role functions as a clinical decision support partner, working across clinical, supervisory, and revenue cycle teams to monitor service utilization, conduct medical necessity reviews, and facilitate timely authorization processes. The UM Clinical Specialist ensures alignment between clinical practice, documentation integrity, and payer expectations, with a focus on compliance, quality, training and education associated with medical necessity and sustainable service delivery. This role is critical to ensuring that the organization delivers clinically appropriate, compliant, and financially sustainable services in alignment with evolving Medicaid and payer expectations while supporting system transformation towards value-based care.
Requirements
- Master’s degree in Social Work, Counseling, Marriage and Family Therapy, or related behavioral health field
- Independent licensure in the State of Ohio required (LISW, LPCC, or IMFT)
- Minimum of 3 years of clinical experience in behavioral health services
- Ability to obtain and maintain First Aid, CPR - adult, child, and infant
- Valid Ohio Driver's license and insurable driving record
- Personal vehicle to transport clients as needed
- Able to pass training to become certified to provide physical intervention as needed
- Valid driver’s license and insurable driving record, if applicable
Nice To Haves
- Experience with Medicaid and/or managed care authorization processes strongly preferred
- Prior experience in utilization management, care coordination, or quality/compliance functions preferred
- Experience working with people with autism spectrum disorders and developmental disabilities preferred
Responsibilities
- Supporting the organization’s clinical utilization management processes to ensure services are delivered in accordance with medical necessity, regulatory requirements, and payer authorization standards.
- Functioning as a clinical decision support partner, working across clinical, supervisory, and revenue cycle teams to monitor service utilization, conduct medical necessity reviews, and facilitate timely authorization processes.
- Ensuring alignment between clinical practice, documentation integrity, and payer expectations, with a focus on compliance, quality, training and education associated with medical necessity and sustainable service delivery.
Benefits
- 401(k) Retirement Plan with 5% Employee Matching after Six Months of Employment– Immediately 100% Vested
- Annual Increases
- 5 Weeks of Paid Time Off
- 8 Paid Holidays
- Medical Insurance
- Flexible Benefit Options Including Dental, Vision and Wellness Support
- Flexible Spending Account (FSA)
- Dependent Care Account (DCA)
- Life Insurance & Supplemental Life Insurance
- Disability Insurance
- Tuition Discount Opportunities with Schools like Capella University & Franklin University
- A Qualified Employer for the Federal Public Service Loan Forgiveness (PSLF)
- Paid Training & Development Opportunities
- Free CE Courses through Capella University to help Maintain Licensure
- Employee Assistance Program (EAP) - Counseling, Therapy, Finance, Legal
- Discount Programs (Ex: Pet Insurance, Movie Tickets, Theme Parks, Costco Membership, etc.)
- Wellbeing Resources (Up to $50 off Health Insurance Premium Monthly)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
