Manager – Utilization Review Position Available In Volusia, Florida

Manager – Utilization Review Top reasons to work for

SMA Healthcare:

Career growth and advancement potential
Great benefits such as: Health, Dental, Vision, Life, & Disability Insurance
Tuition Reimbursement
Paid Personal Leave and Paid Holidays
403b Retirement Plan (matches one to one of employee contribution for the first 3%, then a 50% match on the next 6% of employee contribution) Qualifications
Graduation from an accredited school with a minimum of a Bachelor’s Degree. Master’s Degree and licensed as a

LCSW, LMHC, LCSW

preferred. Minimum of 2 years of supervisory experience in the behavioral health field required. Must be knowledgeable and demonstrate competency in current best practices of behavioral health treatment and related services, especially as it relates to documenting the course of treatment and patient placement criteria in the client record.
Depending on assignment must have knowledge of typical diagnoses, treatment services, and developmental issues for adolescents in general, delinquent adolescents, adults and pregnant/post partum women who are admitted to a mental health and/or substance abuse treatment setting.
Demonstrates proficiency with assigned client populations in performing utilization reviews in records of clients with specific problems and needs.
Knowledge of growth and development.
Ability to assess age specific data.
Ability to interpret age specific response to treatment.
Knowledge of the treatment needs of adolescent mental health, substance abuse, co-occurring, ADD, ADHD, conduct, and oppositional defiant disorders.
Knowledge of the treatment needs of adult mental health, substance abuse, and co-occurring diagnoses of affective disorders, anxiety disorders, PTSD, and antisocial personality disorder.
Knowledge of the treatment needs of adult pregnant/post -partum women with mental health, substance abuse, and co-occurring diagnoses of affective disorders, anxiety disorders, PTSD, and antisocial personality disorder.
Proficiency in working with telephone system and telephone etiquette.
Proficiency in working with computer hardware and software, when assigned. Responsibilities Provide supervision and oversight to the Insurance Verification and Utilization Review staff
Provide assistance in the supervision and oversight of the department assisting with the resolution of administrative and departmental issues.
Provides training and guidance for new hires.
Responsible for the selection of new hires and on-going supervision.
Performs concurrent reviews as assigned by the Clinical Director and/ or Senior Director of Quality Assurance of client records to certify appropriateness of admission and continued stay and discharge planning based on the criteria of the UM Plan.
Performs retrospective reviews as assigned by the Clinical Director and/or Senior Director of Quality Assurance of client records to certify discharge appropriateness of discharge/referrals.
Acts as an advisor to the staff and program supervisors through in-service trainings, individual meetings and written communications issues pertaining to the documentation expectations of insurance companies and other third party payors.
Submits a monthly written and/or oral report detailing the number and percentages of authorizations for each level of care.
Reports on a monthly basis the type of documentation problems that are causing denial of payment for services provided.
Assists in the development of operating procedures
Improves professional knowledge and skill base relevant to utilization management by attending seminars, trainings, and conferences and by reading current literature.
Participates in required SMA in-service trainings to maintain employment.
As assigned, assists in the maintenance of SMA’s compliance with treatment and documentation requirements of funding sources, performance improvement, and accreditation activities.
Acts as liaison between SMA staff and insurance companies, funding sources, or their managed care organizations when client’s health care is being managed under a managed care plan.
When assigned or review requires it, coordinator is knowledgeable of up to date standards/criteria of ASAM PPC, Medicaid, a particular MCO, DCF, and CARF.
Makes commitment to SMA’s mission and core values the SMA Way
Abides by principles of EEO compliance and a workplace of dignity and respect.
Works cooperatively in a group/team setting.
Shows respect to others.
Takes guidance and direction from supervisors.
Arrives/Reports to work on time and ready to work.