Skyland Trail ยท 20 hours ago
Ultilizaton Management Coordinator
Atlanta, GA
Full-time
Onsite
Mid LevelSkyland Trail is a nonprofit mental health residential treatment program for adults and adolescents in Atlanta, and they are seeking a Utilization Management Coordinator. The role involves proactively monitoring the appropriate utilization of services, optimizing reimbursement, and performing various utilization reviews and documentation.
CharityHealth CareMental HealthNon ProfitNursing and Residential Care
Responsibilities
Perform utilization reviews (concurrent reviews) and documentation, as needed
Document all review and authorization information into Profiler within 24hrs of review
Work independently in gathering information for reviews from the client record and by attending treatment team meetings for each recovery track
Obtain insurance precertification for all clients returning to treatment upon hospitalization
Contact MCOs for all level of care increase requests within an hour upon the request
Prepare and submit appeals to MCOs. Schedule peer review and appeals with appropriate clinical staff
Notify appropriate clinical staff of all results from concurrent/peer reviews and appeals
Communicate all discharge clinical information to MCOs
Provides immediate communication to families once continued authorization for treatment has been denied. Review the Non-Covered Services Agreement with families and obtain a completed form with signature for continued treatment
Review and update the error report and collaborate with the finance department
Able to manage a caseload of 30 plus clients
Communicate effectively with families
Attend treatment team daily
Proficiency in written and verbal communication
Other duties as assigned
Qualification
Required
Required degree: at least Masters Degree in counseling, social work, or other human service field
Proactively monitors appropriate utilization of services and optimizes reimbursement
Perform utilization reviews (concurrent reviews) and documentation, as needed
Document all review and authorization information into Profiler within 24hrs of review
Work independently in gathering information for reviews from the client record and by attending treatment team meetings for each recovery track
Obtain insurance precertification for all clients returning to treatment upon hospitalization
Contact MCOs for all level of care increase requests within an hour upon the request
Prepare and submit appeals to MCOs. Schedule peer review and appeals with appropriate clinical staff
Notify appropriate clinical staff of all results from concurrent/peer reviews and appeals
Communicate all discharge clinical information to MCOs
Provides immediate communication to families once continued authorization for treatment has been denied. Review the Non-Covered Services Agreement with families and obtain a completed form with signature for continued treatment
Review and update the error report and collaborate with the finance department
Able to manage a caseload of 30 plus clients
Communicate effectively with families
Attend treatment team daily
Proficiency in written and verbal communication
Crisis Management Skills
Knowledge of CPR and First Aid Procedures
Negotiation Skills
Joint Commission/HIPAA Standards
Managed care (verification, negotiating rates, and pre-certification)
Knowledge of emergency procedures for fire, disaster and unplanned incidents
Medical Records documentation requirements
Medical records confidentiality and disclosure laws
Clinical skills
Computer skills
Candidate must demonstrate interpersonal management with a high level of written and verbal communication skills
Candidate will interface regularly with medical and behavioral health staff, clients, families and various managed care companies
Time management skills are a must
Benefits
9 paid organization-wide holidays
1 paid personal holiday
Accrued PTO
Medical, dental, and vision insurance plans
Employer match toward 403(b) retirement savings account for eligible employees
Employee assistance program for free or reduced financial counseling, mental health counseling, and other confidential professional assistance
As a 501(c) (3) nonprofit organization, Skyland Trail is a Public Service Loan Forgiveness (PSLF) qualified employer. Full-time employees may qualify for the federal student loan forgiveness program
Company
Skyland Trail
Skyland Trail is a nonprofit organization that provides residential treatment, holistic programs, and mental healthcare services.
Founded in 1989
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Ben Hunter, MD, FAPA
Charles B. West Chief Medical Officer
Ray Kotwicki
Chief Medical Officer
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