Utilization Management Clinician
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Collaborates with Utilization Management (UM) counterparts at Managed Care Organizations (MCO) on all aspects of their UM program.
Utilizes clinical skills to coordinate, communicate, & document all aspects of the utilization management process.
Completes intakes and concurrent reviews in order to obtain authorization for services such as Detox, Residential Treatment, Intensive Outpatient, & Assertive Community Treatment.
Performs internal chart audits to confirm that documentation supports medical necessity, that assessments support diagnoses, and that guarantor expectations are met.
Provides ongoing education to clinicians in order to decrease denials, paybacks, & other barriers to service reimbursement and continuity of care.
Participates in transition team for major guarantor changes and assists with the development of new processes to adapt current protocols
Works as part of team to conduct in-house investigations regarding potential fraud and related compliance concerns.
Licensed Clinical Social Worker with over 9 years of experience in behavioral health.
Master of Science in Social Work
