Utilization Manager - 130702

Claratel Behavioral Health • Decatur, GA

4d • Hybrid

About The Position

Claratel Behavioral Health is seeking a dedicated and experienced Utilization Management Manager to oversee the UM functions and ensure appropriate authorization for behavioral health services across the agency. This role oversees the day-to-day functions of operations of utilization review including initial authorizations, concurrent reviews, reauthorizations, and appeals management. The UM Manager collaborates cross-functionally with clinical, billing, compliance, and digital strategies to optimize authorization workflows and ensure quality, coordinated care.

Requirements

• Experience with healthcare information systems and software
• Proficiency in data analysis and report generation
• Excellent analytical and problem-solving skills, with the ability to interpret complex healthcare data and identify trends and patterns.
• Exceptional communication and interpersonal skills, with the ability to liaise effectively with diverse stakeholders, including medical staff, insurance providers, and regulatory agencies.
• Proficient computer skills, including experience with electronic health record systems and Microsoft products.
• Demonstrated leadership abilities, with the capacity to motivate and inspire a team towards achieving organizational goals.
• Strong attention to detail and ability to adhere to strict confidentiality guidelines.
• Demonstrated ability to work independently and manage multiple priorities in a fast-paced environment.

Nice To Haves

• 3-5 years of utilization management experience in a healthcare setting, with at least 2 years in behavioral health
• 2+ years of experience in a supervisory or management role
• Licensed Professional Counselor (LPC) or equivalent with at least 2 years of clinical experience.

Responsibilities

• Supervise staff to coordinate/manage authorization process for Medicaid, CMOs, and State payers.
• Track authorization pends and provides feedback to clinical staff and supervisors regarding utilization trends.
• Assist with denials and provide assistance to clinical staff and supervisors regarding the appeal process and utilization expectations.
• Provide training to clinical staff to improve authorization documentation
• Assist with the development of technical plans which would enable the agency to prepare for possible changes in managed care.
• Provide technical assistance and advice in developing, implementing, and improving clinical programs.
• Customer Support: Responding to phone calls and emails from Clinical Staff
• System Error Coordination: Analyze and problem solve issues with current and planned systems as they relate to the integration and management of client data
• Service Corrections
• Duplicate Client records in EHR
• Documentation Errors
• Implement State Reporting Changes related to authorization in the EHR system
• Reports Prepared and Distributed to the appropriate staff
• AD Hoc Reporting
• EHR system automated reporting

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed