Utilization Management Specialist (3411)

Job Summary:

The Utilization Management Specialist (UMS) works within the Utilization Management Program at Journey Mental Health Center (JMHC).  The UMS works with the team to coordinate insurance needs, process prior authorization requests, and respond to utilization needs for consumers seeking mental health and substance abuse treatment services at JMHC. The UMS also supports other members of the revenue cycle team in processing provider credentialing. The UMS reports to the Revenue Cycle Team Leader and is part of the larger Revenue Cycle team.

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

Journey Mental Health Center upholds a strong commitment to People, Opportunities, Community, and Access (POCA) that guides our daily operations. We foster a caring community for all individuals to feel a sense of belonging. We prioritize delivering services that are centered around ensuring fairness and inclusivity for all. We are dedicated to demonstrating courage and initiative within our agency and community to actively dismantle structural oppression for all affected communities. 

Duties/Responsibilities:

RESPONSIBILITIES

1.   Perform administrative tasks to verify consumer’s insurance and eligibility information, coordinate benefits, and provide feedback to supervisors about these processes in accordance with Journey policies.

2.   Interact with consumers, providing resources and support related to transitions of care or questions regarding benefits and authorizations. 

3.  Communicate with JMHC staff and outside organizations to provide information and assistances related to Utilization Management priorities.

4.   Obtain prior authorizations from payers for needed services at JMHC.

5.   Coordinate with the Utilization Management team to complete credentialing tasks for JMHC staff including reviewing staff/payer/insurance utilization review.

6.   Attend staff meetings, in-services and other program activities as requested.

7.   Participate in JMHC committees, trainings and activities as directed and/or approved.

The above statements are not to be interpreted as an exhaustive list but are intended to describe the general nature and level of work being performed by this employee

Experience

ESSENTIAL

• 1 of relevant experience in directly related work
• Working knowledge of healthcare related insurance systems including registration, verification, referrals, and authorizations
• Ability to master the use of an electronic database (clinical information/billing)
• Working knowledge of computer applications including Word and Excel
• Ability to interact in a professional, thoughtful, and culturally sensitive manner with consumers, co-workers, and staff from other organizations
• Excellent communication skills, (verbal and written)
• Ability to problem solve and provide clarification for clinical staff, accounting staff, insurance companies, and consumers regarding insurance related issues
• Ability to organize and prioritize tasks independently

PREFERRED

• 3 years relevant experience in medical billing or utilization review
• Certification as a trained healthcare insurance specialist from an accredited school
• Ability to speak Spanish and/or Hmong

Physical Requirements:

• Requires driving, sitting, standing, light lifting, bending, and reaching; and the ability to use and operate standard office equipment, including computer, calculator, phone, printer, cell phone, facsimile, etc.

Working Conditions

• Hybrid

Hiring Process:

• All potential candidates will need to successfully pass the Background Information Disclosure (BID) for entity employees and contractors.  Wisconsin’s Caregivers Law requires background, and criminal checks are required by the Department of Health Services and Wis. Stat. 50.065(6)(c) and Wis. Admin Code § DHS 12.05(4)

Journey Mental Health Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.