Utilization & Care Coordination Manager

Acacia Network; New York (NY); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical coverage

Dental and vision coverage

Paid time off

Job summary

Acacia Network is seeking a Utilization Manager to oversee communications with external case managers and MCOs, ensuring data collection, interpretation, and certification/recertification from pre-admission through discharge. The role involves clinical discussion, referral of services to Medical Director when guidelines aren’t met, and review of residential services requiring MCO approval.

The candidate should have strong analytical skills, effective communication with leadership, and experience

Qualifications

• Minimum 2 years of case management and/or utilization review experience.
• Strong problem-solving and advanced analytical skills.
• Excellent oral, written, organizational and interpersonal communication skills.
• Ability to communicate effectively with senior leadership and MCOs.
• Demonstrated ability to collaborate with peers and senior leadership on projects.

Responsibilities

• Obtain pre-authorization/certification from MCOs and communicate changes to Finance.
• Perform ongoing medical necessity reviews and update MCO status as required.
• Serve as liaison between residential program and MCO to facilitate reimbursement.
• Refer denials and non-covered services for appeal and next steps.
• Review medical records for managed care patients within the requested timeframes.
• Collaborate with clinicians to identify discharge needs and coordinate with Social Services.
• Coordinate post-discharge follow-up with patients and community providers.
• Maintain confidentiality and compliance with state/federal regulations.

Job description

Acacia Network is seeking a Utilization Manager to oversee communications with external case managers and MCOs, ensuring data collection, interpretation, and certification/recertification from pre-admission through discharge. The role involves clinical discussion, referral of services to Medical Director when guidelines aren’t met, and review of residential services requiring MCO approval.

The candidate should have strong analytical skills, effective communication with leadership, and experience