Utilization Management Director jobs in North Carolina

Summary

The Utilization Management Coordinator provides support by coordinating the submission of initial and concurrent authorizations for assigned program areas with the goal of ensuring timely and proper authorization.

Principal Duties and Responsibilities

Specific duties and responsibilities:

Service Requests and Authorizations

• Coordinates with program staff to ensure initial and concurrent service authorizations are submitted and received in a timely manner.
• Tracks initial/concurrent service authorizations, denials, authorization gaps, and appeals status.
• Immediately communicates any potential issues or gaps in coverage to supervisor and department directors and works collaboratively with programs to obtain authorization.
• Verifies insurance eligibility.

Utilization Management

• Reviews all documentation required for authorization to assure completeness, post audit readiness and that medical necessity requirements are met, and provides feedback as needed.
• Tracks and reports discharge planning activities to ensure that discharges/transitions are completed in a timely manner.
• Works collaboratively with programs to ensure the agency roster is current.
• Completes pre-billing tasks in a timely manner to ensure timely claims processing, and reimbursement.

Education and Experience Requirements

• Minimum of High School Diploma; Associate level degree preferred
• Knowledge of and professional experience with Medicaid rules and requirements, HIPAA, and other applicable licensing and accreditation requirements.
• Demonstrated proficiency in MS Office software including Office 365, Word, Excel, Outlook, and PowerPoint.
• The successful candidate will also possess the following characteristics:
• Professional demeanor with exceptional interpersonal and organizational skills.
• The ability to be a self-starter and handle multiple projects at once.
• Attentiveness to details
• Ability to provide professional and constructive feedback to program staff.