Behavioral Health Utilization Strategist

mhca.org; Kent (OH); On-site; CAD 75,693 - 92,514; Full time

Benefits offered by this job

Competitive pay starting at $60,000

Team environment and inclusivity

Flexibility and empowerment

Development opportunities

3 weeks PTO in first year

Wellness reimbursement

Job summary

Coleman Health Services is seeking an Utilization Management Specialist to evaluate medical necessity and clinical appropriateness of mental health and substance use disorder treatments. This role links treatment providers with insurance payors to secure authorization and maximize reimbursement.

The position can be based in any Coleman location, with a preference for Kent, OH, and offers a collaborative, diverse work environment with ongoing learning opportunities and three weeks PTO in year one.

Qualifications

• Bachelor's degree in Social Work, Counseling, Psychology or Nursing.
• Current relevant State of Ohio professional licensing.
• 5 years experience in behavioral health or related field.
• Demonstrated knowledge of current and best practices within behavioral health services.
• Demonstrated knowledge of State of Ohio Medicaid Behavioral Health Provider Manual.
• Demonstrated proficiency and experience working on an Electronic Health Record System.

Responsibilities

• Develop and implement process for obtaining prior authorizations for client care.
• Develop and implement utilization management strategies and protocols, in accordance with industry best practices and regulatory requirements.
• Collaborate with medical staff, Case Managers, and other healthcare professionals to evaluate the medical necessity and appropriateness of treatment plans.
• Collaborate with insurance companies, government agencies, and other third-party payers to ensure timely reimbursement and resolve any utilization-related issues.
• Collaborate with Revenue Cycle Management Director regarding claims payments, denials, and payor-based audits.
• Analyze utilization data and trends to identify opportunities for improving care and reducing non-payment of claims.
• Provide coverage for Compliance Officer during periods of absence

Skills

Excellent organizational skills

Windows & MS Office

Education

Bachelor's degree in Social Work, Counseling, Psychology or Nursing

Master's degree in Social Work, Counseling, Psychology or Nursing

Tools

Power BI

SQL

Electronic Health Record System

Job description

Coleman Health Services is seeking an Utilization Management Specialist to evaluate medical necessity and clinical appropriateness of mental health and substance use disorder treatments. This role links treatment providers with insurance payors to secure authorization and maximize reimbursement.

The position can be based in any Coleman location, with a preference for Kent, OH, and offers a collaborative, diverse work environment with ongoing learning opportunities and three weeks PTO in year one.