Utilization Rate Specialist - Dumfries, VA (Hybrid)

Beacon Specialized Living•Dumfries, VA

7d•$50,000 - $55,000•Hybrid

About The Position

The Utilization Rate Specialist monitors, analyzes, and optimizes workforce utilization to support effective resource allocation and organizational productivity goals. The role tracks utilization metrics, identifies trends and gaps, and provides actionable insights to management. Working with business leaders, finance teams, workforce planners, program managers, and clinical staff, the specialist supports appropriate staffing levels, capacity planning, and productive time while maintaining accurate data, producing regular reports, and recommending process improvements. The position also processes and tracks service authorizations and exception rate requests, conducts intake assessments, coordinates with clinical staff and external stakeholders, and maintains accurate client records. Work must comply with company policies, accreditation standards, applicable state and federal licensing requirements, HCBS guidelines, Medicaid requirements, and contractual and regulatory obligations. The role is hybrid, with three days in the office and two remote, and is full-time, Monday through Friday, 8:00 a.m. to 5:00 p.m.; occasional evening and weekend work may be required. The employee is expected to protect confidential information, follow company and regulatory policies, support a safe and respectful workplace, apply and promote trauma-informed care, uphold Beacon’s I CARE core values, and cooperate with regulatory inspections and inquiries. Other duties may be assigned.

Requirements

A minimum of 3–5 years of 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.
Pass required criminal background checks and, where applicable, central registry and child abuse registry checks.
Complete and pass a drug test where applicable.
Possess a valid driver's license and reliable transportation.
Proficient in speaking, reading, and writing English.
Approved by applicable state, federal, and government entities to work within BSLS programs.
Ability to use office equipment, including BSLS information technology systems.
Demonstrated organizational skills and ability to multitask and meet project deadlines.
Excellent oral and written communication skills.
Ability to work well with all levels of the organization.

Nice To Haves

Bachelor’s degree in a behavioral health-related discipline is preferred.

Responsibilities

Review and process service authorization requests in accordance with regulations and state Medicaid guidelines.
Ensure service authorizations align with individualized treatment plans and client needs.
Communicate with internal teams, external providers, and stakeholders to support timely and accurate authorization processing.
Track and document service authorizations, updates, and renewals in compliance with state and federal requirements.
Conduct intake assessments for new clients to determine eligibility and appropriate service levels.
Coordinate with clinical staff to obtain information needed for authorization and service planning.
Manage renewals and reauthorizations for ongoing services to help prevent service disruptions.
Update and maintain accurate, comprehensive client records, including information about services and client progress.
Monitor staffing patterns to ensure adequate coverage and compliance with applicable standards.
Collaborate with program managers and clinical staff to align staffing with service utilization and compliance requirements.
Recommend staffing plan adjustments based on service demand, client needs, and efficiency goals.
Review and process exception rate requests for clients needing services outside standard rates or service parameters.
Collaborate with clinical teams to assess the necessity and justification for exception rate requests.
Submit complete exception rate documentation and justifications to appropriate funding and regulatory bodies.
Evaluate service utilization processes and identify opportunities to improve efficiency, quality, and compliance.
Participate in team meetings and initiatives to optimize the client experience while maintaining regulatory compliance.
Attend approved conferences, trainings, seminars, and professional development activities.
Participate in scheduled leadership calls and report on applicable team KPIs.
Protect the privacy, confidentiality, and security of medical records and other confidential information in accordance with applicable laws, including HIPAA, and contract terms.
Promote Beacon positively, model its core values, and help maintain a respectful, safe, and productive workplace.
Apply and promote trauma-informed care in interactions and organizational practice.
Follow Beacon policies, procedures, and manuals, and cooperate with regulatory inspections, investigations, or inquiries.
Perform other duties as assigned or requested.