Utilization Management Coordinator

3 weeks ago

Macon, United States River Edge Behavioral Health Full time
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 support as well as individuals with intellectual and developmental disabilities. The full continuum of River Edge Behavioral Health services provides 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.

River Edge is looking for an individual who is passionate and motivated to ensure client records have the appropriate authorizations and clinical information necessary for Behavioral Health services to “make life better” for the clients we serve. Benefits Offered: 
  • Competitive Pay 
  • Medical, Dental, Vision Insurance 
  • Paid Time Off 
  • 12 Paid Holidays 
  • 401k with an employer match 
  • Flexible Spending Accounts 
  • Short and Long-term disability coverage 
  • Life Insurance 
  • Employee Discount Program 
]
You will… 
  • Create Connects batch files 
  • Retrieve and process response files from Beacon’s SFTP site 
  • Work Connects documents are rejected, denied, held, 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 the AC file for BHL CSU authorization 
  • Complete the 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 

Must have… 
  • High School Diploma (Bachelors in helping professions 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 
  • 1-3 years of Utilization Management experience 

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. We frequently ask employees to wash their hands, sanitize common areas, to keep other employees and clients safe. 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 makeup, 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. 

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