Utilization Manager

Acacia Network, the leading Latino integrated care nonprofit in the nation, offers the community, from children to seniors, a pathway to behavioral and primary healthcare, housing, and empowerment. We are visionary leaders transforming the triple aim of high quality, great experience at a lower cost. Acacia champions a collaborative environment to deliver vital health, housing and community building services, work we have been doing since 1969. By hiring talented individuals like you, we’ve been able to expand quickly, with offices in Albany, Buffalo, Syracuse, Orlando, Tennessee, Maryland and Puerto Rico.

POSITION OVERVIEW:                                                                                                                                  

This role is responsible for the ongoing collaboration with managed care organizations, with the goal of obtaining and maintaining authorizations for the client’s treatment. 

This position pays: $60,000 annually.

KEY ESSENTIAL FUNCTIONS:                                                                                                                      

• Foster a collaborative relationship with the clinical staff to facilitate case management objectives to ensure appropriate admissions, and increase patient satisfaction, monitors acuity to assure reimbursement.
• Conduct or review assessments of assigned clients, determining clinical and element status using established criteria.
• Analyzes specific utilization problems, and plans and implements solutions that directly influence quality of care and financial liability
• Conduct a thorough chart review and prepares and submits clinical reviews to the MCO’s.
• Identify discharge needs upon admission, request social service and other appropriate referrals.
• Consult and collaborate with clinical staff and other health care professionals to ensure accurate and timely documentation of client progress towards positive clinical outcomes.
• Through a multidisciplinary approach, ensure that the next level of care is appropriate and that the services are in place prior to discharge. 
• Routinely verify the insurance and managed care organization for all assigned clients. 
• Appropriate documentation of discharge plans as needed.
• Will attend and report variances at multidisciplinary rounds on his or her unit on a regular basis.
• Identifies and facilitates resolution of “roadblocks” collects data in support of the utilization management process.
• Interface with managed care companies and other insurance carriers to facilitate timely payment and respond to insurance denials.
• Influence and negotiate with managed care organizations to effectively manage client outcomes. 
• Interacts with providers and facilities in a professional, respectful manner that facilitates the treatment process.
• Performs other related duties as required by director or supervisor.

REQUIREMENTS:                                                                                                                                              

• 2 years’ experience working in or knowledge of the behavioral health field including primary care, women’s health, behavioral health, substance abuse, grants, or related case management programs. 
• Must be educated in current principles, procedures and knowledge of behavior health and have experience in behavioral health managed care or clinical setting.
• Experience working with Managed Care Organizations, preferred. 
• Excellent organizational and communication skills. Ability to multitask, work independently and to work and function under pressure.