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DCCCA Inc. Utilization Management Specialist in Pratt, Kansas

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/ada/r/jobs/11524420

Utilization Management Specialist

Full-Time based in either Wichita or Lawrence, KS

Residential and outpatient treatment for substance abuse, and mental health services are provided by DCCCA across the state of Kansas. The UM Specialist obtains and verifies insurance, and coordinates obtaining benefit information and prior authorization.

Position Overview:

+ Gathers necessary clinical information from facilities to obtain prior authorization and continuing authorizations from private insurance companies

+ Monitors authorization timelines within the ECR and works with clinical staff to ensure continued stay reviews are completed on time within established deadlines

+ Facilitates chart reviews weekly or at the time of the Continued Stay Review for active insurance funded clients to ensure payer standards and medical necessity criteria are met

+ Supports Therapists and other treatment staff to secure clinical information for insurance companies from admission through discharge

+ Facilitates retroactive quarterly chart reviews of private insurance clients to ensure standards are met and recommends continuous quality improvement strategies to address deficiencies

+ Ensures discharge planning and continuing care is documented according to insurance company guidelines

+ Understands and articulates to clinical staff medical necessity criteria for various insurance payers to ensure services are rendered and documented according to those criteria

+ Coordinates retroactive case reviews as requested by insurance companies

+ Coordinates clinical case appeals as necessary

+ Monitors compliance of new admission diagnoses are entered in the ECR by the required 72-hour time frame

Requirements Include:

+ Requires a master's degree in Counseling or another related field; A Registered Nurse (RN) credential is also acceptable

+ Requires at least two years of related experience in mental health, substance use disorder treatment or in a medical setting

+ Requires a basic understanding of the treatment model utilized and a detailed understanding of substance use disorders, including assessment and medical necessity criteria

+ Experience and/or understanding of insurance terminology preferred

+ Requires some travel between DCCCA locations

+ Valid driver's license with a good driving record

+ Must pass pre-employment background checks and drug screening