The Utilization Management Specialist is responsible for executing the UM function, which includes the implementation of case management scenarios, consulting with all services to ensure the provision of an effective treatment plan for all patients. Oversees the response to requests for services and interfaces with managed care organizations, external reviewers, and other payers. Assures that good customer service practices are utilized. Maintains denials and appeals in Midas and reviews the progress of all appeal activity.
QualificationsEducation: Diploma required. Associate or Bachelor Degree in Nursing or Social Work preferred.
Experience: Two (2) years direct clinical experience in a psychiatric or mental health treatment setting preferred. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
Licensure: Valid Indiana Registered Nursing or LCSW preferred
Hours of Work: May be required to work overtime and flexible hours.
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