Utilization Review Manager (Part time, Temporary) Position Available In Davidson, Tennessee

Utilization Review Manager (Part time, Temporary) Sero Mental Health Nashville, TN Please note that this is a part time, temporary position (June through end of October), working about 10-15 hours per week. Sero Mental Health is a leading provider of compassionate, high-quality mental health care. We operate a nationwide network of treatment centers dedicated to supporting individuals with mental health conditions and co-occurring diagnoses. Our purpose is to empower, restore and transform lives, creating healthier communities. Whether through direct patient care, partnerships with providers, or career opportunities for mental health professionals, Sero is committed to transforming lives and advancing mental wellness. The Utilization Manager is primarily responsible for submitting and overseeing the insurance approval and denials processing for multiple remote entities. The responsibility includes the daily/monthly insurance reviews, reconciliations and analysis, working with insurance carriers through peer reviews, processing in compliance with state and federal guidelines.

Primary Responsibilities Include:

Act as facility liaison for VOB issues upon intake. Liaison between insurance companies and facility clinical staff when needed. Completes clinical prior authorizations when required pre-admission. Analyzes client’s clinical status to determine estimated level of care days. Fully understand and maintain policies regarding professional ethics, including appropriate boundaries and client confidentiality; monitor documents according to company and HIPAA policies. Knowledge of current legal standards pertaining to professional practice, reporting requirements, professional boundaries, and relate issues. Reports any immediate safety hazards to appropriate supervisory personnel or maintenance personnel. Understands and adheres to Sero’s compliance standards as they appear in the Company’s Ethics and Code of Conduct Policy and Conflict of Interest Policy. Ensures that the staff are trained and evaluated on their knowledge of and adherence to compliance policies and procedures specific to their jobs. Performs other related duties as assigned.

Requirements:

Bachelors’ Degree in related field or equivalent required. Proven experience as a Utilization Manager. Excellent knowledge of UR processes. Solid knowledge of State and Federal regulations. Well-organized with ability to prioritize. Very good communication and interpersonal skills. Preferred candidates should have sound understanding of mental illness, co-occurring disorders, and milieu therapy. Proficient computer skills and ability use various software programs. Have a valid driver’s license in good standing and auto insurance. Successfully complete drug screen and comprehensive background check. #

GMH Job Types:

Part-time, Temporary Pay:

$25.00 – $30.00 per hour

Benefits:

Flexible schedule

Schedule:

Day shift

Work Location:

Remote