Current jobs related to Utilization Management Specialist II - Cambridge City - Pinnacle Treatment Centers, Inc.

  • Utility Maintenance Technician I or II

    3 weeks ago

    Oregon City, Oregon, United States City of Oregon City, OR Full time

    Salary: $4,364.53 MonthlyJob Type: Full-TimeJob Number: UMS I or II WW/SWDepartment: Public Works OperationsPosition Overview:The City of Oregon City is seeking a dedicated Utility Maintenance Specialist I or II to join our Sewer/Storm Division. This role is vital for maintaining and enhancing the infrastructure that supports our community.Key...

  • Utility Maintenance Technician I or II

    4 weeks ago

    Oregon City, Oregon, United States City of Oregon City, OR Full time

    Salary : $4,364.53 MonthlyJob Type: Full-TimeJob Number: UMS I or II WW/SWDepartment: Public Works OperationsPosition Overview:The City of Oregon City is seeking qualified candidates for the role of Utility Maintenance Specialist I or II within our Sewer/Storm Division. This position offers an excellent opportunity to contribute to the community and enhance...

  • Validation Specialist II

    7 days ago

    Cambridge, Massachusetts, United States Vericel® Corporation Full time

    Validation Engineer IIVericel Corporation, a leader in advanced therapies for the sports medicine and severe burn care markets, is seeking a skilled Validation Engineer II to join our team. As a key member of our validation team, you will be responsible for performing validation in a GMP biotech manufacturing facility.Key Responsibilities:Develop and execute...

  • Validation Specialist II

    24 hours ago

    Cambridge, Massachusetts, United States Vericel® Corporation Full time

    Job Title: Validation Engineer IIVericel Corporation, a leading innovator in advanced therapies for sports medicine and severe burn care, seeks a skilled Validation Engineer II to join our team. As a key member of our Validation Management group, you will play a critical role in ensuring the quality and integrity of our products.Key Responsibilities:Develop...

  • Mental Health Specialist II

    7 days ago

    Cambridge, Massachusetts, United States Dungarvin Full time

    About UsDungarvin is a Minnesota-based industry leader with over 45 years of experience in providing human services. We are committed to creating a supportive environment for individuals with disabilities.Why Work with UsCompetitive wages starting at $20/hourRegular pay increases and opportunities for growthFull-time and part-time schedules...

  • Traveling Ultrasound Specialist

    4 weeks ago

    Michigan City, Indiana, United States Infojini Healthcare II Full time

    Infojini Healthcare II is currently in search of a traveling Ultrasound Specialist for an exciting opportunity. Position Overview & RequirementsSpecialty: Ultrasound SpecialistField: Allied Health ProfessionalDuration: 13 weeks36 hours per weekShift: 12-hour night shiftsEmployment Type: TravelCandidates should possess a minimum of 2 years of experience in...

  • Mechanical Assembly Specialist II

    3 weeks ago

    Kansas City, Missouri, United States OMNI Human Resource Management Full time

    Position OverviewOMNI Human Resource Management is proud to represent a prominent player in the industrial alignment and measurement sector, boasting over 90 years of expertise in delivering innovative solutions. This organization excels in providing engineering and manufacturing answers to the measurement challenges encountered by professionals involved in...

  • Subsurface Utility Engineering Specialist

    1 day ago

    Lake City, Florida, United States T2 UES, Inc. Full time

    Job Title: Subsurface Utility Engineering SpecialistAre you a skilled professional looking for a challenging role in the field of subsurface utility engineering? We are seeking a highly motivated and experienced Subsurface Utility Engineering Specialist to join our team at T2 Utility Engineers, Inc.Job Summary:The successful candidate will be responsible for...

  • Claims Specialist II

    4 days ago

    Garden City, New York, United States Aon Corporation Full time

    Job Title: Claims Specialist IIAon is seeking a skilled Claims Specialist II to join our team. As a Claims Specialist II, you will play a critical role in reviewing and servicing claims in accordance with plan provisions.Key Responsibilities:Review and service claims in accordance with plan provisionsExamine claim submissions and documentation to confirm...

  • Help Desk Specialist II

    1 day ago

    Cambridge, Massachusetts, United States Stratacuity: Proven Scientific Placement Full time

    Job OverviewThe Help Desk Support Specialist II will provide technical assistance to end-users, troubleshoot and resolve basic issues through established processes, and ensure timely and high-quality service.Key ResponsibilitiesAddress and resolve escalated helpdesk requests from managed service providers, ensuring timely and efficient solutions.Offer...

  • Laboratory Specialist II

    17 hours ago

    Cambridge, Massachusetts, United States Thermo Fisher Scientific Full time

    Job SummaryWe are seeking a highly skilled Laboratory Specialist II to join our team at Thermo Fisher Scientific. As a key member of our Unity Lab Services team, you will play a critical role in providing exceptional customer service and support to our clients.Key ResponsibilitiesUse inventory/order management electronic systems to perform tasks such as...

  • Clinical Access Specialist II

    4 weeks ago

    Cambridge, Massachusetts, United States Cambridge Health Alliance Full time

    Position Title: Patient Access Representative II - Obstetrics & GynecologyDepartment Overview: Our practice specializes in Obstetrics and Gynecology, featuring a diverse team of medical professionals including physicians, midwives, and nurse practitioners. We are dedicated to providing culturally competent care to women across various age groups, addressing...

  • Utility Worker II or III

    2 days ago

    Oregon City, Oregon, United States City of West Linn, OR Full time

    Job Title: Utility Worker II or IIIJoin the City of West Linn's Public Works team as a Utility Worker II or III in the Environmental Services Division. This exciting opportunity offers a chance to work alongside a great team, enjoy excellent benefits, and have every other Friday off.Job Summary:We are seeking a skilled and motivated individual to perform a...

  • Claims Management Specialist

    4 weeks ago

    Garden City, New York, United States Orlin & Cohen Medical Specialist Group Full time

    Company Overview:Orlin & Cohen Medical Specialist Group is a leading orthopedic practice in the region, renowned for its extensive network of offices and dedicated healthcare professionals. Position Summary:We are seeking a Claims Management Specialist to join our dynamic team. This full-time role offers a structured schedule from Monday to Friday, with...

  • Public Works Utility Specialist II

    7 days ago

    Kansas City, Kansas, United States Unified Government of Wyandotte County and Kansas City Full time

    Job Summary:As a Construction Worker II with the Unified Government of Wyandotte County/Kansas City, Kansas, you will play a critical role in maintaining and improving the county's infrastructure. This position involves performing a variety of manual maintenance and equipment operation tasks related to sewer line replacement, construction, and repair...

  • Utility Plant Operator II

    6 days ago

    Sun City, Arizona, United States City of Peoria Full time

    Job Title: Utility Plant Operator IIWe are seeking a highly skilled and experienced Utility Plant Operator II to join our team at the Beardsley Wastewater Reclamation Facility. As a key member of our operations team, you will be responsible for the safe and efficient operation of our treatment plant, ensuring compliance with regulatory requirements and...

  • Utility Construction Specialist II

    1 day ago

    Kansas City, Kansas, United States Unified Government of Wyandotte County and Kansas City Full time

    Job SummaryWe are seeking a highly skilled Construction Worker II to join our team at the Unified Government of Wyandotte County/Kansas City, Kansas. This role involves performing a variety of manual maintenance and equipment operation tasks related to the replacement or extension of existing sewer lines, construction of new catch basins or utility access...

  • Asleep Mental Health Specialist II/DSP

    3 weeks ago

    Cambridge, United States Dungarvin, Inc. Full time

    Wage starts at $10.85 (minimum wage for sleep shifts) Are you looking for a second job? Part time work? Additional income? A job that allows you to get paid while sleeping? We've got the job for you! Working an asleep overnight position will help you to gain experience in the field, be able to work while still getting your much needed rest, and have the...

  • Asleep Mental Health Specialist II/DSP

    1 week ago

    Cambridge, United States Dungarvin, Inc. Full time

    Company Description Wage starts at $10.85 (minimum wage for sleep shifts) Are you looking for a second job? Part time work? Additional income? A job that allows you to get paid while sleeping? We've got the job for you! Working an asleep overnight position will help you to gain experience in the field, be able to work while still getting your much needed...

  • Subsurface Utility Engineering Specialist

    11 hours ago

    Lake City, Florida, United States T2 Utility Engineers Full time

    Job Title: Subsurface Utility Engineering SpecialistAre you an experienced utility locator looking for a challenging role in a dynamic company? T2 Utility Engineers is seeking a skilled Subsurface Utility Engineering Specialist to join our team in Lake City, FL.Job Summary:We are looking for a highly motivated and experienced SUE Field Technician to lead our...

Utilization Management Specialist II

4 months ago

Cambridge City, United States Pinnacle Treatment Centers, Inc. Full time
Job DescriptionJob Description

Utilization Management Specialist

Working onsite at our Cambridge City, IN treatment facility

*working collaboratively with the treatment team and health plans to obtain authorization for treatment

We offer competitive salary, full benefits package, Paid Time Off, and opportunities for professional growth.

Pinnacle Treatment Centers is a growing leader in addiction treatment services. We provide care across the nation touching the lives of more than 30,000 patients daily.

Our mission is to remove all barriers to recovery and transform individuals, families, and communities with treatment that works.

Our employees believe we are creating a better world where lives and communities are made whole again through comprehensive treatment.

As a Utilization Management Specialist II, you will need to exhibit excellent communication and documentation skills and work closely with insurers, accrediting bodies, and other healthcare providers. Clinical expertise regarding patient level of care needs is provided to other staff in consultation to ensure proper care in the right amount, scope, and duration. This includes providing utilization review and management (including screening, referral, and information) for mental health and substance abuse services, as well as performing the identification, analysis, and resolution of resource utilization outliers consistent with established protocols, policies, and procedures. As a member of the Utilization Management Team, the Utilization Management Specialist II impacts the delivery of care at the system level through direct utilization management, feedback of performance data, training, and supported consultation. This position provides telephone triage support for the Admissions Department and reviews clinical and financial information to determine eligibility for the appropriate level of care for consumers.

Requirements:

  • Master’s Degree in Social Work, Psychology, Counseling, or related Human Services field is required.
  • Licensed Clinical Social Worker (LCSW), Licensed Psychologist (LP), Licensed Professional Counselor (LPC), or Registered Nurse is required. Licensed Clinical Drug and Alcohol Counselor (LCADC) is preferred.
  • Minimum of five years’ experience in the mental health and substance abuse field required; experience with all target populations and direct experience performing benefits and/or utilization management in a managed care setting preferred.
  • Understand current DSM (Diagnostic and Statistical Manual) and ASAM (American Society of Addiction Medicine) Medical Necessity Criteria and demonstrate competence in making mental health and chemical dependency provisional diagnoses and level of care recommendations with available information.
  • Understand mental health and chemical dependency inpatient, partial hospital, intensive outpatient program (IOP) and outpatient modalities based on an assessment and medical necessity criteria.
  • Can relate and discuss benefits, medical necessity, and clinical information with provider network.
  • Knowledge and background with managed care and insurance.
  • Must possess a current valid driver’s license in good standing in state of employment and be insurable by the designated carrier. This role is required to drive for company purposes.
    • Travel up to 10% may be required to conduct site visits, attend meetings and conferences.

Responsibilities:

  • Maintain prominent level knowledge of behavioral health utilization management criteria and best practices including coordination of care with insurance companies, Medicaid, and other payor sources. Provides, analyzes, and documents collaboration with stakeholders to ensure the consumer receives the most appropriate level of care as designated by medical necessity criteria. Records and analyzes Utilization Management Outcomes to identify trends in stakeholder response to the consumer’s needs.
  • Familiarity with current provider manuals by insurer. Provides information to the treating provider(s) regarding insurance plan specifications of the treatment of substance abuse and mental health.
  • Recommend new models and innovative practices to improve UM functions and cross-collaborative service efficiencies and effectiveness.
  • Model behavior and initiatives consistent with the Pinnacle Treatment Centers mission, vision and values and board focus areas.
  • Identify statistical, programmatic, and clinical outliers utilizing the outlier management database and established agency protocols. Analyze the outlier data, prioritize the data for further analysis and review, and collect sufficient data to complete the consultation process with each affiliate in a manner that seeks to build collaborative relationships with each provider. Analyze the outlier data to identify opportunities for regional development and performance improvement. Fully document all data collected and all analyses conducted during the review process. Develop action plans jointly with relevant providers to address the outliers when required, based on established agency protocols. Provide or arrange onsite reviews/consultation for unresolved outlier management issues and provide final recommendations based on the site review outcome.
  • Provide utilization data for performance improvement and regional development purposes.
  • Identify quality concerns related to programs, specific practitioners, or consumers, and notify the provider and relevant oversight committees (if relevant) of them.
  • Review behavioral health companies updated clinical information on a timely basis for the purpose of utilization management certification, continued stay, and transition of care.
  • Perform daily utilization management functions at designated Recovery Works/Pinnacle location(s) and take appropriate action when necessary. Close communication with the facility treatment teams and accountability to inform leadership of any issues pertaining to complete, accurate, timely documentation.
  • Process appeals with managed care companies. Ensure documentation submitted is complete, accurate, and timely.
  • Participate in multidisciplinary team and Flash meetings for current clinical status and to maintain consistency in documented issues in the Electronic Medical Record.
  • Assist in case management and transition of care duties as assigned.
  • Maintains tracking mechanisms including database administration and file administration for recordkeeping and information retrieval as directed.
  • Provides administrative and clerical support to designated Clinical, Medical, and Revenue Cycle Management departments.
  • Prepares presentations, special reports, correspondence, and documentation of meetings.
  • Utilizes clinical supervision and consultation appropriately to ensure work within scope of practice.
  • Maintains the confidentiality of consumer and other information.
  • Other duties as assigned.

Benefits:

  • 18 days PTO (Paid Time Off)
  • 401k with company match
  • Company sponsored ongoing training and certification opportunities.
  • Full comprehensive benefits package including medical, dental, vision, short term disability, long term disability and accident insurance.
  • Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP)
  • Discounted tuition and scholarships through Capella University

Join our team. Join our mission.  

IND2