Utilization Rate Specialist - Dumfries, VA (Hybrid)

Utilization Rate Specialist

Beacon is a successful and national behavioral health company providing residential-based services and supports to children and adults with Complex Behavioral Health conditions, Severe Mental Illness, Autism, and other compounding medical conditions. All activities related to this position must be delivered in compliance with the company's policies and procedures, accreditation standards, state and federal licensing requirements, HCBS guidelines, and the contractual requirements of Community Mental Health Agencies and other regulatory bodies. You are expected to be aligned with the goals and mission of the organization, and to perform in accordance with our "I CARE" core values of the organization Integrity, Compassion, Advocacy, Respect and Excellence.

The Utilization Rate Specialist is responsible for monitoring, analyzing, and optimizing workforce utilization to ensure effective allocation of resources and alignment with organizational productivity goals. This role supports operational efficiency by tracking utilization metrics, identifying trends and gaps, and providing actionable insights to management. The specialist collaborates with business leaders, finance teams, and workforce planners to ensure appropriate staffing levels, improve capacity planning, and maximize billable or productive time. They play a key role in maintaining data accuracy, generating regular reports, and recommending process improvements to enhance overall performance.

Primary Responsibilities:

• Review and process service authorization requests in accordance with regulations and state Medicaid guidelines.
• Ensure that service authorizations align with individualized treatment plans and client needs.
• Communicate with internal teams, external providers, and stakeholders to ensure timely and accurate processing of service authorizations.
• Track and document service authorizations, updates, and renewals to ensure compliance with state and federal requirements.
• Conduct intake assessments for new clients to determine eligibility and appropriate level of service.
• Coordinate with clinical staff to ensure that all necessary information is obtained for authorization and service planning.
• Manage the renewal process for ongoing services, ensuring that reauthorization is completed in a timely manner to avoid service disruptions.
• Update and maintain client records with accurate, comprehensive information about services provided and client progress.
• Monitor and assess staffing patterns to ensure adequate coverage for client services while meeting the standards set by regulations.
• Collaborate with program managers and clinical staff to ensure that staffing aligns with service utilization and compliance requirements.
• Recommend adjustments to staffing plans based on service demand, client needs, and efficiency goals.
• Review and process exception rate requests for clients who require services outside the standard rate or service parameters.
• Collaborate with clinical teams to assess the necessity and justification for exception rate requests.
• Submit exception rate documentation to appropriate funding and regulatory bodies, ensuring that all necessary information and justifications are included.
• Continuously evaluate service utilization processes to identify opportunities for improvement in efficiency, quality, and compliance.
• Actively participate in team meetings and collaborate on initiatives to optimize the client experience while ensuring regulatory compliance.
• Attends conferences, trainings, seminars and other professional skill development and enhancement activities as approved by leadership.
• Performs other duties as assigned or requested.
• Adheres to BSLS Core Values, Mission Statement, and Corporate Philosophies.

Team Member Expectations:

• Must be compliant with company and regulatory policies and procedures.
• Participate and contribute to weekly, bi-week or monthly leadership calls. Be prepared to report on applicable KPIs that best reflect the performance of your team.
• Preserve and protect the privacy, confidentiality and security of all medical records, proprietary and other confidential information relating to Beacon Specialized Living, its Individuals, Team Members, activities and affiliates, in accordance with all applicable laws (especially HIPAA) and contract terms.
• Promote Beacon in a positive manner and lead by example, modeling our core values in everyday behavior.
• Monitors and corrects employee gossip, harassment, favoritism, and other negative social workplace behaviors to ensure a positive and productive work environment.
• Understand how to approach and communicate with everyone at all levels.
• Treat everyone with dignity and respect while responding to their needs.
• Maintain and sustain a safe community environment and workplace.
• Apply trauma-Informed Care principals recognizing the presence of trauma symptoms and acknowledging the role trauma may play in an individual's life.
• Promote trauma-informed care at all levels of the organization and help create a culture that is sensitive to the feelings of our Individuals and avoid responding negatively to stigmas that they will never truly understand.
• Follow Beacon's policies, procedures, and manuals.
• Cooperates with Beacon Specialized Living, the Department of Human Services (DHS) staff or any other regulatory body during any inspection, investigation or inquiry.
• Accept other duties as assigned.

Professional Conduct and Management Effectiveness:

• Job Knowledge: Depth and breadth of knowledge supporting our organization goals.
• Quality of Work: Freedom from errors and mistakes, timeliness. Accuracy, quality of work in general.
• Quantity of Work: Work output of the employee.
• Reliability: The extent to which the employee can be dependent upon to be available for work, do it properly, and complete it on time. The degree to which the employee is reliable, trustworthy, and persistent.
• Initiative and Creativity: The ability to plan work and to go ahead with a task without being told every detail and the ability to make constructive suggestions.
• Judgment: The extent to which the employee makes decisions which are sound. Ability to base decisions on fact rather than emotion.
• Cooperation: Willingness to work harmoniously with others in getting a job done. Readiness to respond positively to instructions and procedures.
• Compliance: Always be compliant with all company and regulatory policies and procedures.
• Attendance: Faithfulness in coming to work daily and conforming to scheduled work hours.
• Planning and Organizing: The ability to analyze work, set goals, develop plans of action, utilize time, and delegate work as appropriate. Consider the amount of supervision required and the extent to which you can trust employees to carry out assignments conscientiously.
• Directing and Controlling: The ability to create a motivating climate, achieve teamwork, train, and develop, measure work in progress, and take corrective action.
• Decision Making: The ability to make decisions and the quality and timeliness of those decisions.
• Problem Solving: The ability to assess a problem, identify options or solutions, formulate a plan, execute the plan, and achieve and sustain positive outcomes.
• Embrace, support, and manage the business in accordance with Beacon's Mission and Core Values.

Education and Qualifications:

• Bachelor's degree in a behavioral health related discipline is preferred.
• A minimum of 3-5 years' previous experience in a human service-related field, preferably behavioral healthcare.
• At least 2 years of experience in mental health service authorization or utilization management within a community residential setting.
• Must pass criminal background checks, central registry check (in applicable states) and child abuse registry (in applicable states).
• Must complete and pass a drug test, in applicable states.
• Must possess a valid Driver's License and have reliable transportation.
• Proficient in speaking, reading and writing the English language. Approved by state, federal and government entities to work within BSLS programs.
• Ability to use office equipment, including BSLS information technology systems.
• Skills and Abilities: Demonstrated organizational skills and the ability to multitask and meet project deadlines. Excellent oral and written communication skills. Capable of working well with all levels of the organization.

Work Environment:

Hybrid - 3 days office/2 remote

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. Specific vision abilities required by this job include close vision and the ability to adjust focus. This would require the ability to lift files, open filing cabinets, and bend or stand on a stool as necessary.

Position Type/Expected Hours of Work:

This is a full-time position. Days and hours of work are Monday through Friday, 8:00 a.m. to 5:00 p.m. Occasional evening and weekend work may be required as job duties demand. Other