There is a place for you at Highland Rivers Behavioral Health!

Highland Rivers provides treatment and recovery services to individuals impacted by mental illness; substance use disorders and intellectual developmental disabilities.

JOB SUMMARY : The Utilization Management Department works closely with the Billing Department, and other internal programs/external entities to obtain authorization of services rendered by the agency to ensure timely reimbursement. The Utilization Management Specialist also ensures the agency provides quality services and complies with agency, state, and federal guidelines.

Are you ready to make a Difference?

Duties and Responsibilities include:

• Monitor admissions and discharges from the BHCC, including CSC, Temp Observation, and CSU.
• Ensure service orders are entered timely for CSC & Temp Obs.
• Monitor length of stay, track when concurrent authorizations are due based on UM emails, and notify staff. Report any ongoing issues in the Authorization process to UM.
• Aid staff to ensure they understand the authorization process. Participate in UM/BHCC related conference calls and meetings.
• Verify that all individuals have a Connects discharge in place utilizing the Census and No Discharge report.
• Verify that all program histories are closed, not accruing additional Per Diem Claims.
• Track discharge and ensure all documentation is completed and scanned in within 7 days of discharge maximum.
• Maintain up-to-date list of necessary staff to contact at the BHCC.
• Provide training and feedback (both group and 1:1) to staff in order to improve outcomes and increase authorization success and timelines.
• Attend and report out in Daily Ops meeting of any issues relating to Connects Discharges and Authorizations.
• Other duties as assigned.

Requirements

• High School diploma or equivalent
• Experience in mental health or healthcare environment preferred.
• Bilingual abilities a plus.