UTILIZATION MANAGEMENT COORDINATOR

Black Bear Lodge Utilization Management Coordinator

Foundations Recovery Network (FRN) is the premier provider of integrated treatment for co-occurring addiction and mental health concerns, offering residential and outpatient services nationwide. Located in the serene forest foothills of northern Georgia, Black Bear Lodge is a 144-bed place of solace and healing for those individuals suffering from addiction and mental health issues. We are a residential treatment center offering a comprehensive, integrated program that addresses the needs of the whole person—mind, body, and spirit. Our system of care is personalized, evidence-based, and research-proven. Patients can self-reflect and find strength for life change amid the beauty of the expansive sky and the natural tranquility that characterizes our location.

Benefits for a UM Coordinator include:

• Caring, challenging, and rewarding work environment
• Competitive compensation
• Generous paid time off
• Excellent medical, dental, vision, and prescription drug plans
• Career development opportunities within UHS and its 300+ subsidiaries

What do our current UM Coordinators like about working at Black Bear?

• Team collaboration
• Watching the patient growth
• Beautiful campus-great mountain location!
• Highly talented clinical team
• Diverse clientele

Qualifications:

Essential duties and responsibilities include:

• Reviews and understands insurance information provided by the Call Center, determines which benefits are available to the client, and clarifies discrepancies or confusion.
• Determines what level of care (LOC) the client meets and what ASAM (American Society of Addiction Medicine) criteria support that LOC based on client's benefits.
• Once a care manager is established, contacts health plan provider and requests the most appropriate LOC for client.
• Documents in system (NG, UR spreadsheet and Distribution spreadsheet) and in a paper file the request made and authorization approval number/contact information.
• Enters the appropriate LOC in Tier. This is based on the approved insurance LOC. This is updated throughout treatment as the insurance LOC is changed.
• Notifies Business Office within 24 hours of LOC step down or denial.
• Sends daily email with review outcomes to treatment staff indicating LOC, days approved and notification of LOC change.
• Coordinates and assists with scheduling peer reviews.
• Coordinates patient's clinical and after-care needs with treatment team.
• Completes appeal and medical records as instructed.

Education and experience:

• High school degree or GED required, bachelor's degree preferred.
• Nursing degree or bachelor's degree in psychology, social work, or related field preferred or commensurate experience acceptable.
• Minimum of 1 year of experience in utilization review/case management preferred.
• Minimum of 1 year facility based psychiatric/substance abuse experience preferred.

EEO Statement:

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

Notice:

At UHS and all subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience with the best possible career at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail etc. If you feel suspicious of a job posting or job-related email, let us know by contacting us at or View phone number on click.appcast.io.