D203 - Utilization Management - Utilization Management Coordinator

River Edge is looking for an individual who is passionate and motivated to ensure client records have the appropriate authorizations and clinical information necessary for Behavioral Health services to “make life better” for the clients we serve.   The Utilization Management Coordinator monitors appropriate use of services throughout treatment for clients admitted to the inpatient and outpatient program and coordinates authorization with third-party payers.  The UM Coordinator reviews cases for appropriateness of admission, continues stay, and discharge planning while assisting in the promotions and maintenance of high-quality patient care.  This position ensures that the clients have the appropriate level of care, client status, authorizations status, plan of care and meet medical necessity for the behavioral health services.  This role ensures that a patient’s payor has the clinical information with which to authorize the behavioral health and continued stay services to include covered days and associated services.   Benefits Offered:  Competitive Pay  Medical, Dental, Vision Insurance  Paid Time Off  12 Paid Holidays  401k with an employer match  Flexible Spending Accounts  Short and Long-term disability coverage  Life Insurance  Employee Discount Program    You will…  Create Connects batch files  Retrieve and process response files from Beacon’s SFTP site  Work Connects documents in rejected, denied, hold, no CID, multi-final payer and status appropriately  Review discharge connects and flip to UM complete  Manage and process BHL CSU authorizations and update Carelogic  Review and process AC file for BHL CSU authorization  Complete State Discharge process for Fulton locations  Create PTRF referral via Beacon authorization request  Review and process Connects documents in UM review  Run Service delivery, service history, service history (staff credential), ADA group and failed claims reports  Manage Carelogic client discharge process  Review each client record discharge request and create discharge connects, discharge summary      Must have…  High School Diploma (Bachelors in helping profession such as social work, community counseling, counseling psychology, or criminology preferred)  1-3 years of utilization management experience  Attention to detail and ability to work well under pressure  Must effectively manage time  1-3 years of Utilization Management experience    Additional Information:     The Application Process  All qualified applicants will be considered.  This position is subject to close once a satisfactory candidate pool has been identified.  The hiring managers will contact only those selected for an interview.   Applicants who are not selected will receive notification via email.  Due to the volume of applications received, we are unable to provide information on application status by phone or email.    Safe Working Environment  We at River Edge believe every employee has a right to a safe work environment.  Therefore, we require full vaccination of all employees.  Getting the vaccine, frequently washing your hands, sanitizing common areas, and wearing your mask continues to be the most effective way to fight COVID-19.    Diversity and Inclusion  River Edge Behavioral Health is committed to creating a diverse and inclusive work environment and is proud to be an equal employment opportunity employer.  All qualified applicants will receive consideration for employment regardless of race, color, religion, gender, gender identity or expression, sexual orientation, nationality, genetic make-up, disability, age, or veteran status.    Drug-Free Workplace  River Edge Behavioral Health is a drug-free workplace with a longstanding commitment to providing a safe, quality-oriented, and productive work environment.  In compliance with the Drug-Free Workplace Act of 1998, all applicants must pass a satisfactory background clearance and pre-employment drug screen.