Utilization Management Specialist

FLACRA•Village of Clifton Springs, NY

8d•$17 - $18

About The Position

In accordance with the organization’s mission, vision and values, the Utilization Management Specialist is responsible for evaluation of the medical necessity, appropriateness, and efficiency of the use of FLACRA Residential services. The following duties will apply: Duties Understands and works closely with all Managed Care insurance providers and their policies and procedures on grievances and appeals and assists the client in pursuing advocacy as necessary. Works collaboratively with care team, clients, and family to ensure the development of an appropriate treatment plan. Responsible for the completion of admissions and continued stay reviews, obtaining insurance certification/authorization necessary to secure reimbursement. Analyzes insurance and OASAS and Agency standards to determine criteria concerning admissions, treatment and length of stay. Performs all preauthorization and continued stay clinical reviews for insurance companies within required time frames. Predicts and plans for client’s needs from pre-admission, admission, treatment and discharge in collaboration with ACC team members. Determine where potential client would be best served, even if it is not with FLACRA, but another provider chosen by the client. Coordinates appropriate discharge with ACC Clinical and Medical Staff to ensure safe, timely discharge. Assists in coordinating and processing referrals and/or elective admissions. Have a full understanding of each department within FLACRA and how to best utilize capacities. Required to perform Intake phone screens when needed. Functions as a major contributor to bed management and utilization. Monitors and facilitates appropriate utilization of resources. Coordinates with ACC Management Staff to maintain and manage ACC Waiting list. Manage the workflow with minimum interruptions. Provides crisis management and referral services. Other duties as requested or assigned by management.

Requirements

BA, BS, QHP preferred.
At least one year of work experience in the behavioral health field with knowledge of utilization management practices.
Valid NYS Drivers' License.
Excellent written and verbal communication skills.
Demonstrated ability to communicate effectively and work cooperatively with culturally diverse persons, staff and community service providers.
Ability to multi-task, have good problem solving & time management skills and the ability to remain calm in a crisis.
Strong project management skills.
Good assessment, analytical and computer skills.

Responsibilities

Understands and works closely with all Managed Care insurance providers and their policies and procedures on grievances and appeals and assists the client in pursuing advocacy as necessary.
Works collaboratively with care team, clients, and family to ensure the development of an appropriate treatment plan.
Responsible for the completion of admissions and continued stay reviews, obtaining insurance certification/authorization necessary to secure reimbursement.
Analyzes insurance and OASAS and Agency standards to determine criteria concerning admissions, treatment and length of stay.
Performs all preauthorization and continued stay clinical reviews for insurance companies within required time frames.
Predicts and plans for client’s needs from pre-admission, admission, treatment and discharge in collaboration with ACC team members.
Determine where potential client would be best served, even if it is not with FLACRA, but another provider chosen by the client.
Coordinates appropriate discharge with ACC Clinical and Medical Staff to ensure safe, timely discharge.
Assists in coordinating and processing referrals and/or elective admissions.
Have a full understanding of each department within FLACRA and how to best utilize capacities.
Required to perform Intake phone screens when needed.
Functions as a major contributor to bed management and utilization.
Monitors and facilitates appropriate utilization of resources.
Coordinates with ACC Management Staff to maintain and manage ACC Waiting list.
Manage the workflow with minimum interruptions.
Provides crisis management and referral services.
Other duties as requested or assigned by management.