Utilization Review Manager - Home Care jobs in Nebraska

Key Accountabilities:

• Maintains comprehensive working knowledge of markets including government agencies, major payer groups, and key referral sources.

• Responsible for developing and maintaining a positive relationship with referral sources as well as designated communities, and for providing education on topics pertaining to Stephen Center services.

• Manages and accepts referrals. Initiates appropriate communication with clinical and operations teams based on the needs of referred clients/individuals to facilitate appropriate placement and/or services.

• Maintain contact/waiting lists and follow up with potential clients to continue relationships; Uses active phone advocacy, this includes cold call follow-ups to the referral sources and regular email contacts.

• Performs regular follow-up on results of evaluations, proactively promoting services and recruiting and providing support to potential clients, their families, referrals, and payers seeking services.

• Collects, verifies, records and processes client demographics, insurance /payment and referral information.

• Inputs data and completes all placement paperwork. Identifies problems and resolves issues preventing successful documentation/entry.

• Create files for new individuals and ensure intake paperwork has been completed/requested.

• Secure funding information, verify funding/insurance coverage arrangements, and obtain insurance pre-authorization for placement and services.

• Complete all reporting requirements consistent with corporate and regulatory standards.

• Apply knowledge and understanding of programs, policies, procedures, and information to serve as a resource to clients and referral sources and to assist others in resolving administrative issues within scope of authority.

• Run statistical reports for the HERO program for intakes, occupancy and client exits

• Additional responsibilities may be assigned.

Position Requirements:

• Formal training in business or office management, or commensurate work experience in a business setting.

• Credit or non-credit courses in computer fundamentals and the application of basic office management software in the business setting.

• Strong work experience in an administrative position.

• Self-starter/manager.

• Team player with ability to job share.

• Excellent written, oral and interpersonal communication skills.

• Proficiency with PC applications to include Microsoft Word, Microsoft Excel and Access.

• Strong organizational and time management skills.

• Ability to manage and coordinate multiple tasks and balance long and short-term projects simultaneously.

• Ability to manage and work with volunteers.

• Ability to work with staff quickly, accurately and effectively in a dynamic work environment.

• Commitment to the utmost confidentiality in the handling of all client activities, client records, files, etc.

• Conducts self in a manner of professionalism that is conducive to recovery from mental illness, co-occurring disorders and overall wellness, including a minimum of one year of continuous sobriety if in recovery, from the substance for which you are in recovery. Abides by all specific program and Agency procedures, policies, and requirements.

• Work environment characteristics describes here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is not exposed to weather conditions. The noise level in the work environment is usually moderate.

• Ability to two way verbally communicate.

• Sitting-Periodically.

• Standing/Walking-Periodically.

• Kneeling-Periodically.

• Pushing/Pulling-Periodically.

• Lifting up to 25 pounds-Periodically.

PLADC/LADC, BA/BS preferred; relevant experience in lieu of the degree/license will be considered.

BA/BS in Social Work, Psychology, Family Science.