Utilization Management Specialist - FLACRA : Job Details

Utilization Management Specialist

Finger Lakes Addiction Counseling and Referral Agency Inc Clifton Springs, NY (Onsite) Full-Time

$16.50 - $17.50/Hour

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Job Details

Job Title: Utilization Management Specialist

Location: Finger Lakes Region, NY

Employment Type: Full-Time

Job Summary:

FLACRA is seeking an organized and detail-oriented Utilization Management Specialist to support our residential services by evaluating medical necessity, managing authorizations, and optimizing length of stay approvals for clients. In this role, you will collaborate with the care team, clients, and families to ensure appropriate treatment plans and manage the authorization process with insurance providers. This role is crucial in maximizing the efficient use of resources and ensuring compliance with regulatory and agency standards.

Minimum Qualifications:

• Bachelor's Degree (BA or BS) in Health or Human Services preferred.

• Qualified Health Professional (QHP) preferred.

• At least one year of experience in the behavioral health field, with knowledge of utilization management practices.

• Valid NYS Driver's License.

Job Requirements:

Key Responsibilities:

• Collaborate closely with Managed Care insurance providers to understand their policies, including grievances and appeals, and assist clients with advocacy as needed.

• Maximize and increase length of stay approvals for residential services.

• Work with the care team, client, and family to develop and implement appropriate treatment plans.

• Complete admissions and continued stay reviews, obtaining necessary insurance certifications/authorizations to secure reimbursement.

• Analyze insurance, OASAS, and agency standards to determine appropriate admissions, treatment, and length of stay criteria.

• Perform preauthorization and continued stay clinical reviews for insurance companies within the required time frames.

• Collaborate with the care team to predict and plan for client needs from pre-admission through discharge.

• Determine if potential clients are best served by FLACRA or refer them to alternative providers, as appropriate.

• Coordinate with the clinical and medical staff to ensure safe and timely discharge planning.

• Assist with processing referrals and elective admissions as needed.

• Understand and utilize capacities across all departments within FLACRA to best serve clients.

• Conduct intake phone screens as needed to support the admissions process.

• Contribute to bed management and utilization planning.

• Monitor and ensure the appropriate use of resources throughout the client's treatment.

• Work with management to maintain and manage the ACC waiting list.

• Manage workflow efficiently with minimal interruptions.

• Provide crisis management and referral services as necessary.

• Perform other duties as assigned by management.

Skills & Experience:

• Strong written and verbal communication skills.

• Ability to communicate effectively and work collaboratively with culturally diverse individuals, staff, and community service providers.

• Ability to multitask, solve problems, and manage time effectively, especially in high-pressure situations.

• Strong project management skills, with an ability to manage multiple priorities simultaneously.

• Excellent assessment, analytical, and computer skills.

About Us:

Finger Lakes Area Counseling and Recovery Agency (FLACRA) is a growing, not-for-profit provider of behavioral health and substance use treatment services throughout the Finger Lakes Region. Our comprehensive programs include outpatient services, residential care, crisis intervention, vocational support, housing, and youth services. We are committed to providing professional development opportunities for our staff and fostering a collaborative and inclusive workplace.

At FLACRA, we are dedicated to creating an employee-centered culture that values diversity, inclusion, and respect. We encourage candidates from all backgrounds to apply and join our team of professionals committed to making a positive impact in the community.

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Salary Details

This salary was provided in the Job Posting.

$16.50-$17.50

Hourly Salary

Job Snapshot

Employee Type Full-Time

Location Clifton Springs, NY (Onsite)

Job Type Health Care, Nonprofit - Social Services

Experience Not Specified

Date Posted 11/23/2024

Job ID JQZ2Y66DBPWNHXYZ1QP