Utilization Manager: MCO Liaison & Care Coordination

Acacia Network; New York (NY); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

Paid holidays

Job summary

Acacia Network, a leading nonprofit serving New York communities, seeks an Utilization Manager to manage day-to-day coordination with external case managers and MCOs from pre-admission through discharge. You will interpret data, certify/recertify services, and support the interdisciplinary team for medical necessity reviews and proper care planning.

Requirements include a minimum of two years in case management or utilization review, strong analytical and communication skills, and proficiency in

Qualifications

• Minimum 2 years in case management or utilization review.
• Strong analytical and problem-solving skills.
• Excellent written and verbal communication.

Responsibilities

• Obtain pre-authorization/certification from the MCO and notify end of benefit changes to Finance and others as needed.
• Conduct ongoing medical necessity reviews pre-service, concurrent or retrospective.
• Act as a liaison between the residential program and the MCO to facilitate the reimbursement process.
• Refer MCO denials and non-covered services to directors for appeal and next steps.
• Review medical records within 24 to 72 hours of admission and weekly thereafter.
• Collaborate with clinicians to identify discharge needs and coordinate post-discharge care.
• Maintain confidentiality and comply with HIPAA and state/federal regulations.

Skills

Case mgmt

Utilization review

Problem solving

Communication

Collaboration

Tools

MS Word

MS Excel

Job description

Acacia Network, a leading nonprofit serving New York communities, seeks an Utilization Manager to manage day-to-day coordination with external case managers and MCOs from pre-admission through discharge. You will interpret data, certify/recertify services, and support the interdisciplinary team for medical necessity reviews and proper care planning.

Requirements include a minimum of two years in case management or utilization review, strong analytical and communication skills, and proficiency in