Utilization Rate Specialist

Beacon Specialized Living • Mendota Heights, MN

5d

About The Position

The Utilization Rate Specialist is responsible for monitoring, analyzing and reporting on staff and program utilization rates. They will work closely with leadership to ensure records are updated and maintained with comprehensive information and ensure staffing patterns are adequate for the services being provided.

Requirements

• Bachelor’s degree in a behavioral health related discipline is preferred.
• A minimum of 3-5 years’ previous experience in a human service-related field, preferably behavioral healthcare.
• At least 2 years of experience in mental health service authorization or utilization management within a community residential setting.
• Experience with DHS-6790 is required.
• Must pass criminal background check.
• Must possess a valid Driver’s License.
• Proficient in speaking, reading and writing the English language.
• Approved by state, federal and government entities to work within BSLS programs.
• Ability to use office equipment, including BSLS information technology systems.

Responsibilities

• Review and process service authorization requests in accordance with regulations and state Medicaid guidelines.
• Ensure that service authorizations align with individualized treatment plans and client needs.
• Communicate with internal teams, external providers, and stakeholders to ensure timely and accurate processing of service authorizations.
• Track and document service authorizations, updates, and renewals to ensure compliance with state and federal requirements.
• Conduct intake assessments for new clients to determine eligibility and appropriate level of service.
• Coordinate with clinical staff to ensure that all necessary information is obtained for authorization and service planning.
• Manage the renewal process for ongoing services, ensuring that reauthorization is completed in a timely manner to avoid service disruptions.
• Update and maintain client records with accurate, comprehensive information about services provided and client progress.
• Monitor and assess staffing patterns to ensure adequate coverage for client services while meeting the standards set by regulations.
• Collaborate with program managers and clinical staff to ensure that staffing aligns with service utilization and compliance requirements.
• Recommend adjustments to staffing plans based on service demand, client needs, and efficiency goals.
• Review and process exception rate requests for clients who require services outside the standard rate or service parameters.
• Collaborate with clinical teams to assess the necessity and justification for exception rate requests.
• Submit exception rate documentation to appropriate funding and regulatory bodies, ensuring that all necessary information and justifications are included.
• Continuously evaluate service utilization processes to identify opportunities for improvement in efficiency, quality, and compliance.
• Attends conferences, trainings, seminars and other professional skill development and enhancement activities as approved by leadership.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level