Utilization Management Director jobs in Utah

Join Our Team at OCD Anxiety Centers:

At OCD Anxiety Centers, we are passionate about making a difference in the lives of those struggling with anxiety disorders. Through evidence-based practices and continuous learning, we strive to provide the highest quality care to clients and their families. If you're seeking a rewarding career where you can grow both personally and professionally, we invite you to be a part of our team.

What We Offer:

Compensation: Wage starting at $18 per hour (can go up from that depending on candidate experience level) along with a comprehensive benefits package including medical/dental/vision coverage, EAP, 401k match, and more.

Positive Work Environment: Join a team that values integrity, accountability, teamwork, and innovation. We celebrate diversity and strive for excellence in everything we do.

Our Investment in You:

• Core benefits: medical/dental/vision, 401K Match
• Company-paid employee life insurance
• Company-paid Employee Assistance Program (EAP)
• Voluntary Benefits
• Paid Time Off (PTO) Days, Sick Days, Paid Holidays/Flex Holidays

The Purpose of Your Role:

You are an advocate who works with clients and commercial insurance payors to obtain approval for proper treatment services. They promote quality, cost-effective care strategies to payers using evidence-based criteria to meet the care guidelines. You are the company’s connection between health care providers, clients, and insurance companies. After the provider determines the appropriate level of care during the intake, the specialist works with the client through the full approval cycle to help the payor identify medical necessity, appropriateness, and reasonableness of services recommended by the provider. They have a thorough knowledge of payer policies, guidelines, appeals, corrected/voided claim submissions, and stay updated on all-payer changes. You demonstrate excellent customer service skills and communicate professionally and effectively. The individual in this position has overall responsibility for utilization performance improvement, denied authorizations, and operational management of OCD Anxiety Centers Utilization Management Department.

Responsibilities:

• Completes pre-authorizations/concurrent reviews/discharge and peer reviews.
• Applies utilization criteria to monitor appropriateness of admissions with associated levels of care and continued stay review.
• Communicates with commercial and third-party payers for initial and concurrent clinical reviews.
• Reviews clinical documentation in charts to prepare for each review and ensure charts are aligned with insurance company guidelines.
• Coordinates with the treatment team, billing, and clients to obtain proper documentation and authorizations.

Competencies:

• Company Mission: Understand and represent the Mission of OCD Anxiety Centers.
• Customer Service: Focuses on the needs of the customer, whether internal or external, consistently demonstrates superior judgment when dealing with clients, families, customers and other treatment professionals.
• Problem Recognition: When articulating problems or challenges, is solution -focused.

Requirements:

• 2 years experience in customer service, billing, or utilization review
• Familiarity with medical terminology and medical billing practices
• Proficient knowledge of Microsoft Word, Microsoft Excel/Microsoft Office and Google Suite
• Accurate and efficient electronic data entry
• Organized, detail-oriented, takes initiative, and completes job responsibilities independently
• Ability to multitask and problem-solve; strong written and verbal communication skills maintain confidentiality and trustworthiness
• Thrives in a changing work environment
• High school diploma or equivalent

Preferred Qualifications:

• Active SUDC, ASUDC, CSW, LCSW, CMHC, ACMHC, RN, or LPN license
• Working knowledge of EMR software

Equal Employment Opportunity Commission (EEOC) statement

OCD Anxiety Centers is committed to providing equal opportunity for all employees and applicants without regard to race, color, religion, sex, national origin, age, marital status, sexual orientation, genetics, disability, political affiliation, personal appearance, family responsibilities, or any other legally protected class under federal, state, or local law.