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 

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• 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.