Utilization Management Administrator

Job Description

Job Description

SHYS HEALTH is looking for one Utilization Management Admin to join our team. Our ideal candidate is organized, detail oriented, self-driven, ambitious, and engaged.

The Utilization Management Admin is responsible for reviewing treatment authorization requests. It's imperative that the UMS ensures all consumers maintain authorizations and they are documented in the EHR system. The Utilization Management Admin is tracks and monitors UM due dates and sends reminders to the staff to insure consumer documentation is submitted on time and the consumer database is billing ready and monthly documentation has been submitted i.e. NC TOPPS, Target Pops, PCPs, treatment team meetings, CFTs authorizations, etc. renewal dates are updated for timely submission.

Responsibilities

1. Track authorizations of consumers. Run reports of all authorized and non-authorized clients. Request authorization for all unauthorized clients. Email staff to remind them of TAR(treatment authorization request) submission due dates.

2. Review all submitted treatment authorization requests for acuity and completeness. Return all TARs that are incomplete. Enter and submit treatment authorization requests that have been completed accurately to ensure that all consumers maintain authorizations. 

3. Work in a cooperative effort with involved professionals to ensure that program plans are completed, signed by physician/practitioner, and logged so that they may be implemented and services may be authorized, updated, and billed for properly in a timely fashion.

4. Upon receipt of authorization, enter authorization into EHR system. Email all authorizations to appropriate staff. Ensure all clinical data/requests are submitted to the appropriate individuals in a professional and timely manner to ensure all treatment recommendations have been completed by the next auth period.

5. Attend and actively participate in meetings and training as required. Complete any other assigned duty as requested by the supervisor.

Qualifications

• Be able to manage projects; conduct research; and disseminate information by using the telephone, mail services, Web sites, and email.
• Operate a variety of office equipment, including fax machines, photocopiers, scanners, videoconferencing, and multi-line telephone systems.
• Create spreadsheets, compose correspondence, manage databases, and develop presentations, write reports, using desktop publishing Microsoft office software and digital graphics.
• Have at least two years of experience or certification and working knowledge and skill in the application of philosophies, practices, principles, and techniques in designing and implementing medical billing, providing direct care services, and tracking services.

We are looking forward to hearing from you.

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