We are seeking 2 full-time experienced Utilization Manager's for our Non-Intensive Outpatient programs in South Metro-Atlanta. The positions are flex-schedule 3/2 in office & remote work days after initial 60 day start-up.
**Duties:**
- Complete medicaid authorization requests in the GAMMIS system or other systems as indicated for Amerigroup, Cenpatico, Caresource and "Straight Medicaid" (aged, blind, disabled) insurances.
- Manage authorization requests in GAMMIS system & data entry for authorizations into the agency's EHR (NoteNetic System) & set utilization upper & lower limits based on medical necessity in the EHR
- Monitor insurance utilization for up to 120 clients for either Amerigroup, Cenpatico or Caresource
-Input servce code groups into EHR for Amerigroup, Cenpatico, or Caresource
-Collaborate with therapist's to complete treatment plans for individuals served
-Submit reauthorization requests into the GAMMIS system for all assigned insurances
-Colloborate with stakeholders and provide advocacy for individual's served, and provide clinical rationale for services for the individuals served, with the insurances care manager's
-Complete utiization/unit reviews for up to 7 staff at least bi-weekly or according to agency practices and protocols.
-Participate in monthly management team and clinical team staffings/meetings & NIOP monthly program meeting
- Collaborate with internal teams to address utilization
-Other clinical or administrative duties as assigned
**Experience:**
-At least 1 year previous experience providing utilization in Non-intensive community based outpatient (Core) services. 2 years preferred.
-1 year experience using the GAMMIS system
- Knowledge of medical terminology for behavioral health pratitioner type and service delivery
- Familiarity with medical coding for paraprofessional & therapists, documentation review, and medical records
- Proficiency in Sharenote & Notenetic electronic health record systems
- Strong communication and problem-solving skills
- Ability to work effectively with a diverse team
-Licesure as a Licensed Professional Counselor, Licensed Clinical Social Worker preferred
This position offers competitive compensation, health insurance & 401k benefits. If you meet the qualifications and are looking to contribute your expertise in a behavioral health setting, we encourage you to apply.
Job Types: Full-time, Part-time
Expected hours: 30 – 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Healthcare setting:
Schedule:
Education:
Experience:
- Utilization review: 1 year (Required)
License/Certification:
Ability to Commute:
- Jonesboro, GA 30236 (Required)
Work Location: Hybrid remote in Jonesboro, GA 30236