Utilization Manager

4 weeks ago

Chicago, Illinois, United States Carolina Therapeutic Services Health Full time
Job Title: Utilization Manager

Carolina Therapeutic Services Health is seeking a highly skilled Utilization Manager to join our team. As a Utilization Manager, you will play a critical role in ensuring the continuity of care and quality of service to our consumers.

Key Responsibilities:
  • Develop authorizations with Managed Care Organizations (MCOs) to ensure timely and effective delivery of services.
  • Serve as a liaison between the Utilization Department, Lead Therapist, Therapist, Case Managers, and Service Coordinators to ensure seamless communication and coordination of care.
  • Work closely with the Service Coordinators to ensure continuity of care and quality of service to consumers.
  • Ensure Client Rights are being adhered to for all consumers.
  • Responsible for attending to all the rules and regulations of the agency, state, and federal statues, and attending rules of quality improvement, medical records, finance, etc. of the agency.
  • Submit Initial and Concurrent Authorizations to MCOs for assigned contract areas by completing/updating authorization requests forms as needed.
  • Document work, Update and maintain trackers (ICAN, Referral, Master tracker) supplied by supervisor and submit to necessary parties as required by supervisor.
  • Verify client insurance coverage for authorization submission.
  • Coordinate with MCO to resolve documents issues submitted for authorizations.
  • Gather and Review accuracy and complete all referral forms, intake forms, ICAN/Screenings forms prior to submitting to MCO.
  • Communicate with program managers when authorizations are completed, and clients are ready to be billed. Provide program managers electronic copy of ICANs.
  • Track and review ICANs/Screening scores for accuracy all new clients for completion of intake, ICANs/Screenings. Communicate to Therapist Lead and Intake Coordinator if not completed in timely manner.
  • Add client demographics and client goals and update as needed to OnTarget system.
  • Identify and add authorizations for ICANs/Locus, OPT, CM, CS, PSR (update as needed).
  • Complete initial and updated Beacons.
  • Identify if ICANS/LOCUS have been billed and billed on correct dates. Will contact Lead Therapist if any issues.
  • Report critical concerns and problems to Supervisor in a timely manner and actively seek Supervisor's input and assistance to resolving the concern.
  • Reports to supervisor on a weekly basis.
Requirements:
  • Must be at least 18 years of age, be able to read, write and effect both written and verbal communication successfully.
  • Understand and follow directions.
  • Possess no substantiated findings of abuse or neglect listed on Health Care Registry, and no criminal convictions.
  • Higher school diploma or its equivalent.
  • Work requirements and Certification/Licenses Requirements:
    • Orientation to CTS Inc.
    • Receive training in population served, and client's rights/confidentiality.
    • Experience with HIPAA and System Of Care is required.
    • Participate in and successfully complete all required trainings.
    • The employee must become privileged/credentialed in delivery of services.
    • CPR/First Aid, Medication Administration and Preventive Disease will be required.
    • Demonstrate core skills and training to deliver services.
    • Must have adequate transportation to deliver services, maintain required level of vehicle insurance in order to deliver services necessary to participate in consumer activities, i.e. hiking, sporting, education, etc.
    • Criminal records check, finger printing, and HCPR check is a prerequisite for employment consideration.
    • Maintain a Valid Driver's License or State Identification.

Carolina Therapeutic Services Health is an equal opportunity employer and welcomes applications from diverse candidates. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.

How to Apply: If you are a motivated and detail-oriented individual who is passionate about delivering high-quality care to our consumers, please submit your application, including your resume and cover letter, to [insert contact information].

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