Gateway Foundation Inc

Role Description Utilization Management Specialists are responsible for: - Obtaining initial and subsequent authorizations of clinical services from insurance and government payors. - Reviewing clinical records and determining the appropriateness of patient admission, level of care, continued length of stay, and discharge. - Providing training and support to clinical treatment staff on the insurance authorization process. - Assisting staff with preparing peer-to-peer reviews and clinical appeals by advising them on presenting case information in accordance with established procedures. - Preparing regular summary reports and presentations on utilization management data. - Other duties as assigned. Qualifications - Comprehensive knowledge of treatment planning and behavioral healthcare clinical documentation, therapeutic services, intervention techniques, and medical records review. - Bachelor’s degree in counseling, nursing or a closely related field. Master’s degree preferred. - Knowledge and familiarity with the utilization management process in order to maximize appropriate treatment as indicated by client needs and comply with regulations, policies and procedures. - Understanding of diagnoses and ability to collect, analyze and report on utilization management data at a level normally acquired through three to five years progressively more responsible related experience in a healthcare setting. - Proficiency in computer software applications such as Microsoft Word and Excel to complete required forms, reports, and analyses. - Familiarity with electronic health record systems to review patient records and determine appropriateness of patient care. - Advanced communication skills to effectively present information verbally and in writing and work collaboratively with others. - Advanced interpersonal skills necessary to provide advice and counsel to managers and employees. - High level analytical skill necessary to interpret insurance contracts and provisions. - A current and valid driver’s license, in order to travel to other sites to participate in trainings and meetings. Requirements - Proofreading and checking documents for accuracy on a continual basis (critical). - Ability to use a keyboard and video display terminal to receive, retrieve, and/or audit information and data. - Ability to respond to telephones, pages and speech. - Normal or corrected vision in order to read and audit files. - Ability to operate a motor vehicle safely and remain alert to traffic signs and conditions in order to travel to assigned sites. Benefits - Health and Wellness: - Medical, dental, and vision insurance for employees and dependents. - Employee wellness program promoting health and fitness and offering cash-saving premiums. - Employee assistance programs focused on mental health. - Financial Wellbeing: - 403(b) Retirement Plan with 3% employer match. - Short-term and Long-term Disability and Life and AD&D Insurance paid for by Gateway. - Flexible Spending Accounts for medical and dependent care. - Public Service Loan Forgiveness (PSLF). - Flexibility and Time Off: - 18 paid time off days per year – accrual rates increase with years of service. - 9 paid company holidays. - Work-life-balance. - Personal Development: - Training & Development Programs. - Tuition Reimbursement - up to $5,250 per calendar year. - eLearning access to online courses that provide CEU’s and job-related training. - Clinical Supervision: Formal and informal guidance.