Utilization Management Director jobs in Utah

Join Our Team at OCD Anxiety Centers:

At OCD Anxiety Centers, we are passionate about making a difference in the lives of those struggling with anxiety disorders. Through evidence-based practices and continuous learning, we strive to provide the highest quality care to clients and their families. If you're seeking a rewarding career where you can grow both personally and professionally, we invite you to be a part of our team.

What We Offer:

Competitive Compensation: Earn a wage starting at $18 per hour along with a comprehensive benefits package including medical/dental/vision coverage, 401k match, and more.

Positive Work Environment: Join a team that values integrity, accountability, teamwork, and innovation. We celebrate diversity and strive for excellence in everything we do.

Our Investment in You:

• Core benefits: medical/dental/vision, 401K Match
• Company-paid employee life insurance
• Company-paid Employee Assistance Program (EAP)
• Voluntary Benefits
• Paid Time Off (PTO), Sick Days and Paid Holidays/Flex Holidays
• Paid specialized ongoing training, strengthening your skills, experiences, and connections that help advance your career

The Purpose of Your Role:

The UM specialist is an advocate who works with clients and commercial insurance payors to obtain approval for proper treatment services. They promote quality, cost-effective care strategies to payers using evidence-based criteria to meet the care guidelines. They are the company’s connection between health care providers, clients, and insurance companies. After the provider determines the appropriate level of care during the intake, the UM specialist works with the client through the full approval cycle to help the payor identify medical necessity, appropriateness, and reasonableness of services recommended by the provider. They have a thorough knowledge of payer policies, guidelines, appeals, corrected/voided claim submission, and stay updated on all-payer changes.

The UM specialist demonstrates excellent customer service skills and communicates professionally and effectively. The UM specialist required effective communication and coordination with the Director of Utilization Management, with fellow UM specialists, insurance companies, and treatment team to obtain the maximum benefit for our clients. The individual in this position has overall responsibility for utilization performance improvement, denied authorizations, and operational management of OCD Anxiety Centers Utilization Management Department. The position entails coordinating and managing concurrent and retrospective reviews of all client’s medical records over the continuum of care. The UM specialist is responsible for completing admission, concurrent and peer reviews as well as initiating denials and appeals. The UM specialist ensures cases are reviewed and responded to in a timely and clinically sound manner in accordance with policies and procedures.

Expectations:

• Understands and utilizes relevant laws and best practices
• Adheres to all company policies and procedures
• Presents self in a professional manner

Responsibilities:

• Completes pre-authorizations/concurrent reviews/discharge and peer reviews.
• Applies utilization criteria to monitor appropriateness of admissions with associated levels of care and continued stay review.
• Communicates with commercial and third-party payers for initial and concurrent clinical reviews.
• Document actions and information shared with the treatment team or third-party payers.
• Reviews clinical documentation in charts to prepare for each review and ensure charts are aligned with insurance company guidelines.
• Collect data on variances in LOC, lost days, cost/barriers to discharge and denied days.
• Schedules and completes peer-to-peer reviews and coordinates crucial appeals.
• Initiate single-case agreements and work collaboratively with payer relations team to execute rates and secure authorization.
• Reviews clinical documentation.
• Reviews the quality of documentation provided to assure adequacy and clinical appropriately for current LOC.
• Coordinates with the treatment team, billing, and clients to obtain proper documentation and authorizations.
• Coordinates benefits and transition between various levels of care.
• Communicates all UM related information with the treatment team to share updates with clients and families regarding the status of current authorization.
• Ensure that all deficiencies identified through the performance improvement analysis are addressed with appropriate problem-solving actions.
• Learns and practices de-escalation techniques (may occasionally be exposed to high-stress environments).
• Maintains a clean and orderly environment.
• Demonstrate a professional attitude and support the objectives of the facility mission and philosophy through internal and external communications and interactions with all levels of staff, clients and community and referral sources.

Competencies:

• Company Mission: Understand and represent the Mission of OCD Anxiety Centers.
• Cultural Sensitivity: Has the knowledge, skills, attitudes and beliefs to work well, respond effectively to, and be supportive of people in cross-cultural settings.
• Customer Service: Focuses on the needs of the customer, whether internal or external, consistently demonstrates superior judgment when dealing with clients, families, customers and other treatment professionals.
• Appropriate Boundaries: Demonstrate an awareness of personal and professional boundaries; demonstrates consistency in disposition.
• Listening Skills: Demonstrates professional humility and willingness to learn and demonstrate an ability to confront others in appropriate and timely manner; possesses understanding and is able to communicate clearly and effectively in a one-to -one or group setting.
• Professionalism: Is willing to accept responsibility and accountability for behavior; abides by organizational policies and procedures; addresses staff and professionals in an appropriate and timely manner.; speaking respectfully and listening closely.
• Teamwork: Demonstrates ability to influence others in a positive direction; when conflict arises among team members, is quick to take accountability for role in conflict and is willing to serve and goes above and beyond what is expected in most situations.
• Ability to Take Action: Communicates needs, concerns, asks questions and seeks guidance from supervisor when uncertain; works effectively within team setting, demonstrating willingness to be flexible with fellow team members when indicated and avoids needless conflict.
• Crisis Management: Makes effort to raise staff and employee awareness of security and safety of the facility and environment; able to maintain composure in the midst of difficult/stressful situations.
• Problem Recognition: When articulating problems or challenges, is solution focused.
• Research/Analysis: Makes self an asset and resource for other staff; assist and supports all members of the team.

Requirements:

• 2 years experience in customer service, billing, or utilization review
• Familiarity with medical terminology and medical billing practices
• Proficient knowledge of computers: Microsoft Word, Excel, and other computer software
• Accurate and efficient electronic data entry
• Must be maintain excellent attendance
• Organized, detail-oriented, takes initiative, and completes job responsibilities independently
• Multitask, problem-solve, interpersonal skills, and strong written and verbal communication skills maintain confidentiality and trustworthiness
• Thrives in a changing work environment including inside, outside, and loud noise level
• High school diploma or equivalent

Preferred Qualifications:

• Proven experience as a Billing Coordinator or similar position
• Active SUDC, ASUDC, CSW, LCSW, CMHC, ACMHC, RN, or LPN license
• Working knowledge of EMR software
• Team management and leadership skills

Equal Employment Opportunity Commission (EEOC) statement

OCD Anxiety Centers is committed to providing equal opportunity for all employees and applicants without regard to race, color, religion, sex, national origin, age, marital status, sexual orientation, genetics, disability, political affiliation, personal appearance, family responsibilities, or any other legally protected class under federal, state, or local law.