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D203 - Utilization Management - Utilization Management Coordinator

1 month ago

Macon, United States Riveredge Full time

175 Emery Hwy, Macon, GA 31217, USA

Req #185 Wednesday, July 17, 2024 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. River Edge offers outpatient services at our Emery Highway-Macon, Monroe County and Baldwin County locations. Outpatient services include behavioral health, nursing, and psychiatric assessment, stabilization and medication maintenance services as well as crisis intervention services as well as awareness, education and recovery groups.

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. The Utilization Management Coordinator

monitors

appropriate use

of services throughout treatment for clients admitted to the inpatient and outpatient program and coordinates authorization with third-party payers

.

The UM Coordinator reviews cases for appropriateness of admission, continues stay, and discharge planning w

hile

assisting

in the promotions and maintenance of

high-quality

patient care

.

This position ensures that the clients have the

appropriate level

of care, client status,

authorizations

status, plan of care and meet medical necessity for the behavioral health services

.

This role

ensures

that

a

patient’s payor has the clinical information with which to authorize the behavioral health and continued stay services to include covered days and associated services. B

enefits Offered: Competitive Pay 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… C

reate 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 Review and process Connects documents in UM review Run Service delivery, service history, service history (staff credential), ADA group and failed claims reports M

ust have

… 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 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. We at River Edge believe every employee has a right to a safe work environment

.

Therefore, we require 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 COVID-19. 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. If you are looking for an opportunity to make life better and a strong desire for personal growth we encourage you to apply. We promptly review all applications. Highly qualified candidates will be contacted for interviews.

We are an equal opportunity employer and highly value diversity.We do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

All selected applicants must pass a satisfactory background clearance and pre-employment drug test.

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