Utilization Review Care Mgr / PAS BHN IP

Hartford HealthCare; Farmington (CT); In loco; USD 55.000 - 85.000; Tempo pieno

Descrizione del lavoro

Hartford HealthCare in Farmington, CT seeks a Behavioral Health Utilization Coordinator to manage patient care authorizations and coordinate with clinical teams. You will liaise with managed care companies, ensure timely level-of-care approvals, and document activities in the medical record system.

Responsibilities include collaborating with payors, tailoring treatment plans to coverage, and supporting discharge planning.

Competenze

• Minimum: Bachelor’s degree with 5 years’ experience in behavioral health.
• Preferred: Master’s degree with 3 years’ experience in behavioral health.
• Licenses in behavioral health are required or preferred.

Mansioni

• Coordinates the care of clients with clinical staff and referrals.
• Liaises with insurance companies to obtain authorizations for care.
• Inputs information into Medical Record System to ensure complete authorizations.
• Collaborates with payors and clinicians to determine appropriate level of care.
• Ensures admission, stay, and discharge meet program criteria.
• Communicates with referral sources about benefits and pre-certifications.
• Maintains records and prepares statistical reports as assigned.
• Supports appeals process as directed by management.

Formazione

Bachelor’s degree

Master’s degree preferred

LPC, LADC, LMFT, LCSW

Descrizione del lavoro

Location Detail: 9 Farm Springs Rd Farmington (10566)

Work where every moment matters.

Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.

With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary

Coordinates the care of clients in collaboration with clinical program staff. Liaison with insurance companies and other referral sources. Obtains level-of-care authorizations from managed care companies when clinically necessary. Requires in-depth knowledge of behavioral health services in order to accurately articulate and advocate for patient’s care requirements and effectively obtain authorizations.

Ensures that authorizations are current and documented as required.

Position Responsibilities

Key Areas of Responsibility

• Obtains level-of-care authorizations from managed care companies when clinically necessary. Requires in-depth knowledge of behavioral health services in order to accurately articulate and advocate for patient’s care requirements and effectively obtain authorizations.
• Accurately inputs information into Medical Record System to ensure authorizations are complete. Error or omissions here may result in loss of payment.
• Collaborates with the payor source and the primary clinician/treatment team and refers clients to appropriate level of care, based on symptomatology and benefit structure.
• Ensures client admission, continued stay, and discharge meet the criteria of the program.
• Communicates with referral sources to determine benefits and pre-certify admissions.
• Maintains records and prepares statistical reports as assigned. Enters data into business software and other business systems as required.
• Assists with process of appeals as directed by the Manager – Utilization Review.
• Performs other duties as assigned.

Qualifications

Requirements and Specifications

Education

• Minimum: Bachelor’s degree with 5 years’ experience in behavioral health setting
• Preferred: Master’s degree preferred with 3 years’ experience in behavioral health setting or Bachelor’s degree with 5 years’ experience in behavioral health setting

Experience

• 5 year’s experience in behavioral health setting
• Documented assessment skills of biopsychosocial needs of behavioral health clients

Licensure, Certification, Registration

• LPC, LADC, LMFT, LCSW

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.