UTILIZATION MANAGEMENT COORDINATOR
About The Position
Foundations Recovery Network (FRN) is the premier provider of integrated treatment for co-occurring addiction and mental health concerns, offering residential and outpatient services nationwide. Located in the serene forest foothills of northern Georgia, Black Bear Lodge is a 144- bed place of solace and healing for those individuals suffering from addiction and mental health issues. We are a residential treatment center offering a comprehensive, integrated program that addresses the needs of the whole person—mind, body, and spirit. Our system of care is personalized, evidence-based, and research-proven. Patients can self-reflect and find strength for life change amid the beauty of the expansive sky and the natural tranquility that characterizes our location.
Requirements
- High School Degree or GED required
- Minimum of 1 year of experience in utilization review/case management preferred.
- Minimum of 1 year facility based psychiatric/substance abuse experience preferred.
Nice To Haves
- Bachelor's degree preferred
- Nursing degree or bachelor’s degree in psychology, social work, or related field preferred or commensurate experience acceptable.
Responsibilities
- Reviews and understands insurance information provided by the Call Center, determines which benefits are available to client, and clarifies discrepancies or confusion.
- Determines what LOC the client meets and what ASAM (American Society of Addiction Medicine) criteria support that LOC based on client’s benefits.
- Once a care manager is established, contacts health plan provider and requests most appropriate LOC for client.
- Documents in system (NG, UR spreadsheet and Distribution spreadsheet) and in a paper file the request made and authorization approval number/contact information.
- Enters the appropriate LOC in Tier. This is based on the approved insurance LOC. This is updated throughout treatment as the insurance LOC is changed.
- Notifies Business Office within 24 hours of LOC step down or denial.
- Sends daily email with review outcomes to treatment staff indicating LOC, days approved and notification of LOC change.
- Coordinates and assist with scheduling peer reviews.
- Coordinates patient’s clinical and after-care needs with treatment team.
- Complete appeal and medical records as instructed.
Benefits
- Caring, challenging, and rewarding work environment
- Competitive Compensation
- Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- Career Development opportunities within UHS and its 300+ Subsidiaries
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
