Job Description
Job Description
Now Hiring : Utilization Review Manager
Location : Southern Peaks Regional Treatment Center | 700 Four Mile Parkway | Canon City, CO 81212
Salary From : $80,000
Job Type : Full-time
As a Utilization Manager (UM) , your primary function is to monitor and track reviews for new admissions for appropriate placement and to request additional authorization, if applicable. In addition, you will assist with completing requests for new admissions and monitoring and resolving eligibility issues. As a Utilization Manager , you are responsible for ensuring all documentation meets contract requirements and is complete from admission to discharge. In this role, you will be a liaison between the program(s) and the Managed Care Organizations (MCOs).
Who We Are :
Abraxas Youth & Family Services is a national nonprofit human services provider dedicated to Building Better Futures for at-risk youth, adults, and families. Our diversified array of services includes alternative education, outpatient counseling, in-home services, shelter, detention, residential treatment and re-entry / transition services.
Since 1973, Abraxas team members have positively impacted the lives of those we serve and the communities in which they live.
Benefits & Perks : We provide a competitive and comprehensive benefits program that offers the protection, peace of mind and flexibility designed to support you – both at home and at work.
- Medical & Dental & Vision Insurance
- Flexible Spending Accounts
- Basic Life & Short-Term Disability Insurance
- 401(k)
- Life Assistance Program (LAP)
- Tuition Assistance Program
- Paid Time Off (PTO)
- Paid Holidays
- Paid Training
- Advancement Opportunities
Utilization Manager (UM)
Essential Functions :
Reviews authorizations for placement and referral which includes providing referral authorizations, concurrent reviews, proactive discharge and transition planning and appropriate referral to case management.Monitors all utilization reports to assure compliance with reporting and turnaround times.Performs continued stay and retrospective reviews for movement to another level of care.Prepares and submits clinical appeals for inappropriate referrals.Impacts length of stay and influences use of resources by sharing knowledge with clinical and medical staff as well as community resources.Monitors patient’s clinical progress and coordinates patient care from admission to discharge.Assists clinical staff with chart audits and filing to assure compliance with contract requirements.Encourages optimum utilization of medical care, appropriate level of care and utilization of hospital bedsKeeps current with regulation changes and informs staff of all updates and changes..Maintains current knowledge of community agencies and services, medical necessity and clinical criteria for Residential Treatment Center (RTC) level of care.Demonstrates knowledge of and maintains records associated with Prison Rape Elimination Act (PREA).Attends staff meetings and participates in department activities and programsIndependently manages assigned caseload on a daily basis, assists other staff members with high / low census, provides coverage after normal working hours or weekends as facility needs indicate.Communicates effectively with clients, support services, and co-workers; uses communication systems effectively (i.e. Communication Log, E-Mail, Shift Plans, Feedback Log, Status Recommendation Sheet, Incident Reports).Implements Company policies.Maintains knowledge of each client’s problem areas.Maintains safety & security of clients & facility.Conducts frequent headcounts.Minimum Education and Experience Requirements :
Master’s degree in a related health field and a minimum of one year working experience in behavioral health preferably with Medicaid / RAE’s.Bachelor’s degree in behavioral health field and two years working experience in behavioral health preferably with Medicaid / RAE’s.Experience working with Medicaid and state-specific behavioral healthcare systems, and demonstrated skills in working, communicating, and collaborating with state agencies; hospital utilization review experience or managed care background preferred.Other Qualifications :
At least twenty-one (21) years of age.Criminal clearances and background check.Valid driver's license from employee’s state of residence.Valid registered vehicle insurance.Ability to work with computers and the necessary software typically used by the departmentWhy Should You Consider Abraxas?
At Abraxas , we celebrate the richness of our diverse employees and the communities we serve. We are actively committed to building a culture of awareness and belonging, as we strive to ensure we are a welcoming, inclusive, and culturally competent organization.As we work to make a difference in people’s lives, we are dedicated to respect, equity, and the engagement of those we serve and our employees.As a provider of trauma-informed care, we firmly believe in recovery and that our clients can lead fulfilling and meaningful lives, and we consider it an honor and a privilege to assist them in their journey.Whether you’re looking to begin a rewarding career or you’re a seasoned professional wanting a new challenge, we have a place for you and opportunities for development at all levels.At Abraxas , everything we do centers around people. That is why we are committed to providing you with competitive pay and comprehensive benefit options that help make your life easier and healthier, with a focus on providing choice when it comes to physical, emotional and financial wellness. Our benefit options meet you where you are in your life and set you up for success both in and outside of work.If you want to have a positive impact in the lives of others, come join us!Equal Opportunity Employer
Abraxas Youth & Family Services , an affiliate of Apis Services Inc., offers a rewarding career for those passionate about making a difference in the lives of others. 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.
Join Us in Building Better Futures!
Interested in joining our outstanding team? If you have any questions, you can contact us by email at recruiting@jobsatabraxas.org
Now Hiring : Utilization Review Manager
Location : Southern Peaks Regional Treatment Center | 700 Four Mile Parkway | Canon City, CO 81212
Salary : $80,000
