UTILIZATION MANAGER in Shelby, Ohio, US at The Geo Group

Date Posted: 9/26/2018

Job Snapshot

Job Description

Facility: ABRAXAS OF OHIO

Compensation Base: $48,000 annually DOE

Compensation Bonus (if applicable): 

 

Equal Opportunity Employer.

Abraxas Youth and Family Services is a national leader in the operation of residential treatment facilities and community-based programs for troubled youth and their families. We offer a wide array of services to include life skills, mental health services, cognitive behavioral therapy, family counseling, drug and alcohol treatment, case management services, recreational activities as well as vocational and educational services.

Abraxas is a great place to start your career whether you have a high school diploma or GED, military experience, some college, or a bachelor or advanced degree.  If you are interested in counseling, juvenile justice, psychology, social work, teaching or just want to make a difference, we have a career path for you. Help change lives at Abraxas Youth and Family Services.

 

Abraxas Ohio
2775 State Route 39
Shelby, Ohio  44875
 
www.jobsatabraxas.com
 

Summary

This is a professional position providing admission, continued stay and discharge reviews on all clients. This position will maintain positive relationships with referral sources and insurance companies, track admissions and continued stay and discharge requirements for all referrals. The incumbent works directly to reduce uncovered days of funding, investigates cases with insurance and referral sources to recuperate lost days of funding. Performs other duties as assigned.

 

Primary Duties and Responsibilities

  • Provide the insurance company with accurate information to ensure full financial coverage for each client day.
  • Provide the referral source(s) with timely information to ensure good customer focus. Maintain client confidentiality providing a safe therapeutic treatment.
  • Establish a system to increase knowledge of ever changing funding system and identify trends and areas of improvement.
  • Contacts external case managers/managed care organizations for certification and re-certification of insurance benefits throughout the client’s stay, and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning.
  • Possesses a thorough understanding of the patient’s treatment through communication with the treatment team.
  • Advocates for the client’s access to services during treatment team meetings and through individual physician contact.
  • Coordinates payor benefits and length of stay approvals for clients.
  • The incumbent will monitor, coordinate, and provide necessary verbal and written documentation as required by the payor.
  • Analyzes individual medical cases to determine eligibility for medical care.
  • Obtains pre-certification for clients and conduct reviews to determine if patients are eligible for services based on client benefit and coverage rules.
  • Reviews the cases of clients who are not covered for certain services, to determine if the care is needed by analyzing medical records.

 

Job Requirements

Minimum Requirements

The following educational requirements are acceptable for this classification including:

  • Bachelor’s degree plus four (4) years related experience.
  • Licensed chemical dependency counselor LCDC III; LICDC preferred.
  • The preferred candidate has working knowledge of Medicaid and state-specific behavioral healthcare systems and demonstrated skills in working with state agencies and communication/collaboration.
  • Hospital utilization review experience or managed care background preferred.

 Other Qualifications:

  • At least twenty-one (21) years of age.
  • Criminal clearances (specific State & child clearances and, if necessary, FBI).
  • Non-communicable diseases physical exam.
  • Valid driver's license from employee’s state of residence.
  • Valid registered vehicle insurance.

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