UTILIZATION MANAGEMENT SPECIALIST

Job Summary:

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.

Must Have Qualifications:

• Associates Degree in Business Administration or Health/Human Services.
• One year administrative experience in a behavioral health setting.
• Valid NYS Drivers’ License.
• Knowledge of utilization management practices.
• Strong interpersonal communication skills.
• General knowledge of medical insurance.

Nice to Have Qualifications :

• Bachelors Degree in Business Administration or Health/Human Services.
• Qualified Health Professional - CASAC, CASAC-T, CASAC-P.
• Supervisory or managerial experience.

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, client, 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.

Other Skills/Knowledge and Experience:

1. Excellent written and verbal communication skills.

2. Demonstrated ability to communicate effectively and work cooperatively with culturally diverse persons, staff and community service providers.

3. Ability to multi-task, have good problem solving & time management skills and the ability to remain calm in a crisis.

4. Strong project management skills.

5. Good assessment, analytical and computer skills.

About Us:

Finger Lakes Area Counseling and Recovery Agency (FLACRA) is a growing, not-for-profit behavioral health and substance abuse treatment provider with decades of experience and multiple innovative program located throughout the Finger Lakes Region. Our services include outpatient, residential, crisis center, vocational, housing and youth services. We pride ourselves on being committed to the professional development of all our staff and if that is important to you, we invite you to choose FLACRA!

FLACRA is an equal opportunity employer committed to fostering an inclusive, diverse workplace. We are dedicated to creating an employee-centered work culture, where all individuals feel valued and respected. We encourage candidates from all backgrounds to apply and join our team of professionals, who are dedicated to our community’s recovery & mental health care needs.

Job Type: Full-time

Pay: $19.00 - $22.00 per hour

Expected hours: 37.5 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Associate (Required)

Experience:

• Medical billing: 1 year (Required)
• Medical Insurance: 1 year (Required)

License/Certification:

• New York State Drivers License (Required)

Ability to Commute:

• Clifton Springs, NY (Required)

Ability to Relocate:

• Clifton Springs, NY: Relocate before starting work (Required)

Work Location: In person