Utilization Management Coordinator

Company: River Edge
Location: Macon
Posted on: September 14, 2023

Job Description:

Utilization Management Coordinator

About River Edge Behavioral Health

Serving more than 10,000 Georgians, River Edge continues to be one of the state's leading resources for mental health, substance use disorder treatments and supports as well as individuals with intellectual and development disabilities. The full continuum of River Edge Behavioral Health services provide state-of-the-art treatment and support services for more than 13,000 children, youth, families and adults annually, who experience mental illness, addiction, co-occurring disorders or developmental disabilities.

This position requires a person who is passionate and motivated to ensure client records have the appropriate authorizations and clinical information necessary for Behavioral Health services in order to "make life better" for the clients we serve.

In this role:

• Duties & Responsibilities
  
  • Create Connects batch files
  • Retrieve and process response files from Beacon's SFTP site
  • Work Connects documents in rejected, denied, hold, no CID, multi-final payer and status appropriately
  • Review discharge connects and flip to UM complete
  • Manage and process BHL CSU authorizations and update Carelogic
  • Review and process AC file for BHL CSU authorization
  • Complete State Discharge process for Fulton locations
  • Create PTRF referral via Beacon authorization request
  • Review and process Connects documents in UM review
  • Run Service delivery, service history, service history (staff credential), ADA group and failed claims reports
  • Manage Carelogic client discharge process
  • Review each client record discharge request and create discharge connects, discharge summary
    Minimum Training & Experience
    
    • High School Diploma (Bachelors in helping profession such as social work, community counseling, counseling psychology, or criminology preferred)
    • 1-3 years of utilization management experience
    • Attention to detail and ability to work well under pressure
    • Must effectively manage time
      All selected applicants must pass a satisfactory background/motor vehicle clearance and pre-employment drug test.
      
      Additional Information:
      
      The Application Process
      
      • All qualified applicants will be considered.
      • This position is subject to close once a satisfactory candidate pool has been identified.
      • The hiring managers will contact only those selected for an interview.
      • Applicants who are not selected will receive notification via email.
      • Due to the volume of applications received, we are unable to provide information on application status by phone or email.
        Safe Working Environment
        
        We at River Edge believe every employee has a right to a safe work environment. Therefore, we recommend full vaccination of all employees. Getting the vaccine, frequently washing your hands, sanitizing common areas, and wearing your mask continues to be the most effective way to fight.
        
        Diversity and Inclusion
        
        River Edge Behavioral Health is committed to creating a diverse and inclusive work environment and is proud to be an equal employment opportunity employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, gender, gender identity or expression, sexual orientation, nationality, genetic make-up, disability, age, or veteran status.
        
        Drug-Free Workplace
        
        River Edge Behavioral Health is a drug-free workplace with a longstanding commitment to providing a safe, quality-oriented, and productive work environment. In compliance with the Drug-Free Workplace Act of 1998, all applicants must pass a satisfactory background clearance and pre-employment drug screen.
        
        At Will Workplace
        
        Employment with River Edge Behavioral Health is at will. At-will means your employment relationship with River Edge Behavioral Health or Affordable Business Solution is for an indefinite period and is subject to termination by you or River Edge Behavioral Health, with or without cause, with or without notice, and at any time.
        
        River Edge Behavioral Health is an Equal Opportunity Employer: River Edge Behavioral Heath recruits qualified candidates for positions in its service area. It is the policy of River Edge Behavioral Health provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination or harassment of any type without regard to race, color, sex, religion, national origin, age, disability, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Keywords: River Edge, Macon , Utilization Management Coordinator, Executive , Macon, Georgia