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UM/Data Specialist
2 months ago
The Community Service Board of Middle Georgia is dedicated to providing those we serve with quality innovative behavioral healthcare in a recovery-based environment. CSB of Middle Georgia is recognized as a state leader in comprehensive behavioral healthcare providing integrated cost-effective services. CSB of Middle Georgia is located in Dublin, Georgia, and the agency currently serves residents of Bleckley, Dodge, Johnson, Laurens, Montgomery, Pulaski, Telfair, Treutlen, Wheeler, and Wilcox counties in Georgia; and in our Ogeechee Behavioral Health Division, serving residents of Burke, Emanuel, Glascock, Jefferson, Jenkins, and Screven counties in Georgia. We value Quality, Professionalism, Person-Centered, Recovery, Teamwork, Improvement, Accountability, Management of Practicing Information, Wellness, and Financial Stability.
The Community Service Board of Middle Georgia is searching for a Utilization Management (UM)/Data Specialist for the HOPE IC3 Program The Utilization Management/Data Specialist will be responsible for working cross-functionally with our Utilization Management department to ensure that Medicaid and other authorizations are handled by their appropriate deadlines. The UM/Data Specialist will report to the Dublin, Georgia office, if local. Remote options may be available for highly qualified candidates.
Responsibilities of the UM/Data Specialist:
- Complete authorization service summaries for CMO consumers in a timely fashion.
- Send CMO OTR summary requests to the Utilization Management team before the necessary deadlines.
- Complete ASO for APS Medicaid/FFS/State Contracted consumers as additional units are needed or previous authorizations expire.
- Communicate with Utilization Management team immediately after receiving authorizations.
- Checks insurance verifications monthly to ensure none have been discontinued or changed. Work to get OTRs completed same day; if so.
- Tracks dates submitted to Utilization Management department, Program Director and/or Case Manager if authorization requests go unanswered after a specified duration of time.
- Maintains accurate authorization of unit’s system and will check for accuracy and need of additional service request summaries daily.
- Monitors/Updates Carelogic forms as needed for CMO/Medicaid/FFS/State contract cases to ensure required information can be submitted with OTR summary.
- Gathers case summary information needed from Care Coordinators, Certified Peer Specialists and/or Wraparound Supervisors and will develop summaries to be sent to the Utilization Management department.
- Communicates trends and problems with Program Director and Wraparound Supervisors that may hinder authorizations from being completed.
- Work reports submitted from the Utilization Management department and Carelogic to ensure that authorizations issues are resolved to ensure no billing concerns occur.
- Checks payor sites and with Utilization Management for changes affecting authorization for services, communicating new information with all appropriate parties involved.
- All other duties as assigned.
Requirements & Qualifications:
- High School Diploma/GED (or equivalent) required, bachelor’s degree in a related field preferred.
- Previous experience working with qualitative data and research
- Proficiency in Microsoft Office products
- Attention to detail and problem-solving skills
- High level of professionalism
- Strong written and verbal communication skills
- Excellent time management & organizational skills
Monday - Friday
8:00 AM - 5:00 PM
