Ultilizaton Management Coordinator presso SKYLAND TRAIL

Description

Skyland Trail, a nonprofit mental health residential treatment program for adults and adolescents in Atlanta, is seeking a Utilization Management Coordinator

Scope:

Proactively monitors appropriate utilization of services and optimizes reimbursement.

Duties:

• Perform utilization reviews (concurrent reviews) and documentation, as needed
• Document all review and authorization information into Profiler within 24hrs of review
• Work independently in gathering information for reviews from the client record and by attending treatment team meetings for each recovery track
• Obtain insurance precertification for all clients returning to treatment upon hospitalization
• Contact MCOs for all level of care increase requests within an hour upon the request
• Prepare and submit appeals to MCOs. Schedule peer review and appeals with appropriate clinical staff
• Notify appropriate clinical staff of all results from concurrent/peer reviews and appeals
• Communicate all discharge clinical information to MCOs
• Provides immediate communication to families once continued authorization for treatment has been denied. Review the Non-Covered Services Agreement with families and obtain a completed form with signature for continued treatment
• Review and update the error report and collaborate with the finance department
• Able to manage a caseload of 30 plus clients
• Communicate effectively with families
• Attend treatment team daily
• Proficiency in written and verbal communication
• Other duties as assigned

Competencies:

• Crisis Management Skills
• Knowledge of CPR and First Aid Procedures
• Negotiation Skills
• Joint Commission/HIPAA Standards
• Managed care (verification, negotiating rates, and pre-certification)
• Knowledge of emergency procedures for fire, disaster and unplanned incidents.
• Medical Records documentation requirements
• Medical records confidentiality and disclosure laws.
• Clinical skills
• Computer skills

Proficiencies:

Candidate must demonstrate interpersonal management with a high level of written and verbal communication skills. Candidate will interface regularly with medical and behavioral health staff, clients, families and various managed care companies. Time management skills are a must.

Qualifications

Qualifications:

Required degree: at least Masters Degree in counseling, social work, or other human service field.

Salary & Benefits

Competitive salary commensurate with experience.

Benefits include:

• 9 paid organization-wide holidays
• 1 paid personal holiday
• Accrued PTO
• Medical, dental, and vision insurance plans
• Employer match toward 403(b) retirement savings account for eligible employees
• Employee assistance program for free or reduced financial counseling, mental health counseling, and other confidential professional assistance
• As a 501(c) (3) nonprofit organization, Skyland Trail is a Public Service Loan Forgiveness (PSLF) qualified employer. Full-time employees may qualify for the federal student loan forgiveness program

Workplace Culture:

Skyland Trail is a nonprofit mission-focused organization with five campuses in Atlanta and about 150 employees. Employees work collaboratively in small teams. Cross-departmental committees and working groups help ensure quality and performance improvement. Each and every employee plays an important role in our clients healing and recovery.

Skyland Trail respects and values individuals and their diverse histories, abilities, identities, and perspectives. We work to ensure all aspects of our organization reflect our commitment to diversity, inclusion, and cultural equity

Commitment to Community Health:

Skyland Trail values the health of our staff and clients and has taken steps to ensure a healthy campus and community. Please note that Skyland Trail is a 100% nicotine-free campus. There is no smoking, vaping, or tobacco use permitted anywhere on campus, indoors or outdoors. Skyland Trail also recommends employees to be fully vaccinated for Covid-19 and to receive a CDC-approved influenza vaccination annually.