Behavioral Health Utilization Strategist

Coleman Professional Services; Kent (OH); On-site; USD 54,000 - 66,000; Full time

Benefits offered by this job

Competitive salary starting at $60k

Team-oriented culture

Flexible work environment

Professional development opportunities

Paid time off 3 weeks first year

Wellness reimbursement

Job summary

Coleman Health Services is seeking an Utilization Management Specialist. The role supports mental health and substance use treatment programs and may be based at any Coleman location, with preference for Kent, OH.

You will evaluate medical necessity, coordinate prior authorizations, and partner with providers and payers to maximize appropriate reimbursement. The role requires a bachelor’s degree in a relevant field, Ohio licensure, and 5 years in behavioral health, plus EHR and MS Office

Qualifications

• Bachelor's degree in Social Work, Counseling, Psychology or Nursing.
• Current Ohio license.
• 5 years in behavioral health or related field.
• Knowledge of Medicaid Behavioral Health Provider Manual.
• Experience with EHR systems and Microsoft Office.
• Knowledge of Power BI dashboards and SQL is a plus.

Responsibilities

• Develop and implement process for obtaining prior authorizations for client care.
• Develop utilization management strategies and protocols per best practices and regulatory requirements.
• Collaborate with medical staff, case managers and providers to evaluate medical necessity and treatment plan appropriateness.
• Collaborate with payers to ensure timely reimbursement and resolve utilization issues.
• Coordinate with Revenue Cycle Management regarding claims and denials.
• Analyze utilization data to identify opportunities to improve care and reduce non-payment.
• Provide coverage for Compliance Officer during absences.

Skills

Organizational skills

Windows & MS Office

Education

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

Master's degree preferred

Tools

Power BI dashboards

SQL

Electronic Health Record (EHR) system

Job description

Coleman Health Services is seeking an Utilization Management Specialist. The role supports mental health and substance use treatment programs and may be based at any Coleman location, with preference for Kent, OH.

You will evaluate medical necessity, coordinate prior authorizations, and partner with providers and payers to maximize appropriate reimbursement. The role requires a bachelor’s degree in a relevant field, Ohio licensure, and 5 years in behavioral health, plus EHR and MS Office