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Utilization Management Representative in Behavioral Health Services; Full-Time; Days

Company: Chestnut Health Systems
Location: Bloomington
Posted on: January 11, 2019

Job Description:

Overview

Chestnut Health Systems is a leading provider of behavioral and primary health care services. Over four decades, Chestnut has grown to over 700 committed, compassionate employees providing substance use, mental health and primary care treatment to patients in Central and Southern Illinois. We provide fully integrated care for all of our patients by combining behavioral health care services with our community-based primary care health centers. Chestnut also conducts research and training throughout the U.S.A.

Chestnut Health Systems is seeking a full-time Utilization Management Representative in Behavioral Health Services for our Bloomington, IL facility.

**Please note to be considered for a position you must attach a resume, complete the application, and answer all screening questions.

Responsibilities

Assist with the coordination and facilitation of pre-certification activities for Substance Abuse and designated Mental Health programs: Use available resources (census emails, billing console, Outlook calendars, Medi site) to identify new admissions that require UM action.
Communicate with assigned staff regarding assessment/evaluation information.
Provide clinical information to insurance/managed care company according to established procedures.
Complete admission authorizations within expected time frames.
Document approval/denial from insurance/managed care company.
Communicate approval/denial from insurance/managed care company to appropriate staff.


Conduct concurrent review activities for Substance Abuse and designated Mental Health programs: Document upcoming reviews for each program in the team calendar.
Review the client file to determine and gather information that will be beneficial in the review process.
Communicate with assigned staff regarding clinical documentation and updates.
Provide the insurance/managed care company with updated clinical information by the established due date.
Document approval/denial from insurance/managed care company.
Communicate approval/denial from insurance/managed care company to appropriate staff.


Coordinate and conduct clinical appeals/denials activities for Substance Abuse and designated Mental Health programs: Communicate with appropriate staff regarding the process of the review.
Coordinate the appeal, including making arrangements with appropriate medical personnel, when required.
Where possible, take responsibility for conducting the appeal teleconference.
Document the appeal decision.
Communicate the appeal ruling to appropriate staff.


Assist Accounts Receivable staff with claims appeals/denials activities: Provide copies of all information faxed to managed care/insurance companies for inclusion in the client file.
Provide clear details of approvals and denials, including corresponding contact and confirmation numbers, in file documentation.
Work with AR to appeal claims denials (if services had been approved), as requested.
Maintain active communication with AR staff regarding atypical situations that may affect the claims collection process.
Work in cooperation with AR regarding determination of client funding sources and discovered updates to this.


Attend staff meetings of assigned programs on a weekly basis.
When seeking insurance approvals, maintain a focus beyond simple abstinence, representing the client's ongoing treatment needs associated with development of a recovery lifestyle.
With both insurance organizations and internal team members, choose interactions that reflect the recovery values of Hope, Respect, Empowerment, Health and Wellness and Spirituality and Connectedness.
Serve as a liaison between managed care companies and clinical programs as required to solve problems, enhance services, and increase customer satisfaction.
Serve as a guide and educator to the clinical programs on the UM process and the information that is needed to secure managed care/insurance approvals.
Promote Chestnut's culture of customer service excellence through the adherence to Chestnut's behavioral standards for customer service.

Qualifications

Minimum of a bachelor's degree in counseling, psychology, social work or a related field, plus three (3) years' direct clinical experience in the provision of behavioral health services required.
Master's degree and licensure preferred.
The ideal candidate will have experience with effectively presenting chemical dependency/substance use disorder clinical information to insurance and managed care organizations, as well as being skilled in organization, attention to detail, documentation/record keeping, communication, teamwork and customer service.
Computer skills and the ability to learn an EMR are necessary.
Satisfactory completion of Chestnut's background checking process.

This full-time position includes an excellent compensation and benefits package including health, dental, vision, life, and disability insurance, a retirement savings plan with company match, generous paid time off benefits, and more.

For immediate consideration, please see us at www.chestnut.org/employment

***For additional information and inquiries text "Chestnut" to 97211



Chestnut welcomes applications from qualified individuals with recovery experience.

EOE - Minorities/Females/Vets/Disabled

Keywords: Chestnut Health Systems, Bloomington , Utilization Management Representative in Behavioral Health Services; Full-Time; Days, Executive , Bloomington, Illinois

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