Job Information
Finger Lakes Area Counseling & Recovery FLACRA Utilization Management Specialist in Clifton Springs, New York
Full job description link here: https://www.indeed.com/jobs?q=flacra&l=geneva%2C+NY&sort=date&vjk=416376af26a5b087 - Job Title: Utilization Management Specialist Location: Finger Lakes Region, NY Employment Type: Full-Time
Job Summary:
FLACRA is seeking an organized and detail-oriented Utilization Management Specialist to support our residential services by evaluating medical necessity, managing authorizations, and optimizing length of stay approvals for clients. In this role, you will collaborate with the care team, clients, and families to ensure appropriate treatment plans and manage the authorization process with insurance providers. This role is crucial in maximizing the efficient use of resources and ensuring compliance with regulatory and agency standards.
Minimum Qualifications:
Bachelors Degree (BA or BS) in Health or Human Services preferred. Qualified Health Professional (QHP) preferred. At least one year of experience in the behavioral health field, with knowledge of utilization management practices. Valid NYS Drivers License. Key Responsibilities:
Collaborate closely with Managed Care insurance providers to understand their policies, including grievances and appeals, and assist clients with advocacy as needed. Maximize and increase length of stay approvals for residential services. Work with the care team, client, and family to develop and implement appropriate treatment plans. Complete admissions and continued stay reviews, obtaining necessary insurance certifications/authorizations to secure reimbursement. Analyze insurance, OASAS, and agency standards to determine appropriate admissions, treatment, and length of stay criteria. Perform preauthorization and continued stay clinical reviews for insurance companies within the required time frames. Collaborate with the care team to predict and plan for client needs from pre-admission through discharge. Determine if potential clients are best served by FLACRA or refer them to alternative providers, as appropriate. Coordinate with the clinical and medical staff to ensure safe and timely discharge planning. Assist with processing referrals and elective admissions as needed. Understand and utilize capacities across all departments within FLACRA to best serve clients. Conduct intake phone screens as needed to support the admissions process. Contribute to bed management and utilization planning. Monitor and ensure the appropriate use of resources throughout the clients treatment. Work with management to maintain and manage the ACC waiting list. Manage workflow efficiently with minimal interruptions. Provide crisis management and referral services as necessary. Perform other duties as assigned by management. Skills & Experience:
Strong written and verbal communication skills. Ability to communicate effectively and work collaboratively with culturally diverse individuals, staff, and community service providers. Ability to multitask, solve problems, and manage time effectively, especially in high-pressure situations. Strong project management skills, with an ability to manage multiple priorities simultaneously. Excellent assessment, analytical, and computer skills. About Us:
Finger Lakes Area Counseling and Recovery Agency (FLACRA) is a growing, not-for-profit provider of behavioral health and substance use treatment services throughout the Finger Lakes Region. Our comprehensive programs include outpatient services, residential care, crisis intervention, vocational support, housing, and youth services. We are committed to providing professional development opportunities for our staff and fostering a collaborative and inclusive workplace.