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Utilization Assistant

2 months ago

Fort Wayne, Indiana, United States Maple Heights Behavioral Health Full time

Job Summary:

The Utilization Assistant - Clinical Support Specialist will provide administrative support to the Utilization department at Maple Heights Behavioral Health. This role will be responsible for performing pre-certification and negotiating continued stay with third-party payers, gathering data to support case management activities, and coordinating discharge planning with the clinical team.

Key Responsibilities:

  • Pre-Certification and Negotiation: Perform pre-certification and negotiate continued stay with third-party payers to ensure timely and cost-effective care for patients.
  • Case Management: Gather data to support case management activities, including presentation of gathered data and case notes, to ensure effective care coordination.
  • Discharge Planning: Coordinate discharge planning with the clinical team, maintain CRM database with discharge information, and follow up to ensure a smooth transition of care.
  • Communication: Present case information and the needs of third-party payers to relevant stakeholders, ensuring clear and effective communication.
  • Admissions Review: Assist in admissions review, concurrent reviews, and discharge planning to ensure compliance with regulatory requirements.
  • Peer Review: Assist physicians in peer review by serving as an information resource, gathering data to support review, and scheduling peer review.
  • Performance Improvement: Inform management about the status of current patients, document utilization activities as instructed, and participate in performance improvement activities.

Qualifications:

  • Education: High school diploma or equivalent required.
  • Certifications: Current certification as a Registered Addiction Specialist, certified Substance Abuse Counselor, or similar certification preferred.

Working at Maple Heights Behavioral Health:

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal, and local laws. We strive to create a work environment that is inclusive, respectful, and supportive of all employees.