Utilization Case Manager
4 weeks ago
We are seeking a highly skilled Utilization Case Manager to join our team at Helio Health. As a Utilization Case Manager, you will play a critical role in enhancing our program's efforts to track, review, and analyze data relating to continuous quality improvement.
The successful candidate will work on a Full-Time basis, supporting our Inpatient, Detox, and Residential programs. In addition to our comprehensive benefits package, this position is eligible for a Sign-On incentive up to $1,500.
Key Responsibilities:
- Review precertification requests for medical necessity, referring to the medical provider those that require additional expertise.
- Review clinical information for concurrent reviews, extending the length of stay for patients/residents as appropriate.
- Assist in developing and administering policies and procedures for utilization.
- Negotiating access to care for individuals seeking services at Helio Health, Inc.
- Educate program staff on current principles and standards of practice surrounding utilization and denials management.
Requirements:
- Associate's degree required, Bachelor's degree preferred.
- Licensed/credentialed applicants preferred.
- Two years of experience in utilization review in a hospital, health care, or managed care setting.
- Knowledge of federal and state regulations applicable to treatment and reimbursement.
- Utilization review procedures and techniques.
Our Comprehensive Employee Benefits Package Includes:
- Health insurance including dental and vision for employees and families.
- Paid Vacation and Sick leave - No Waiting Period for accruals.
- Paid holidays, including a floating birthday holiday.
- 401(k) plan with up to 5% company match.
- Company paid short-term disability insurance.
- Company sponsored life insurance.
- Employee Assistance Program (EAP).
Helio Health provides equal opportunity to all employees and applicants for employment, without regard to race, creed, color, sex (including pregnancy, gender identity and sexual orientation), parental status, religion, national origin, citizenship, status as a victim of domestic violence, age, military or veteran status, handicap or disability, family medical history or predisposing genetic characteristics or carrier status, marital status, family status, political affiliation, felony conviction record, status as a victim of a crime, or status as an employee who has complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit, or any other categories, status or activity protected by federal, state or local law.
Salary and hourly compensation ranges are provided in accordance with NYS law and are based on Helio Health's good faith belief of what is accurate at the time of posting.
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