Manager Optum Utilization Review Jobs in Colorado

Jefferson Center's Youth Residential Recovery (YRR) mission is to provide intensive substance use disorder treatment in the ASAM Level of Care 3.5 residential treatment setting for Colorado youth ages 13 years of age up to 18.5 years of age. 

The Utilization Management Coordinator possesses knowledge of Substance Use Disorders and diagnosis, as well as the ability to articulate those indicators professionally. The UM Coordinator manages medical necessity by evaluating the client medical records to determine the medical necessity concerning the ASAM and determining the appropriateness of level of care. Serves as liaison for clients, referral sources, stakeholders, and insurance companies. Negotiates and advocates for client length of stay and level of care. Oversees utilization review activities to ensure reimbursement for services. The UM Coordinator leads daily treatment team meetings, manages authorizations/reauthorizations and reviews. The UM coordinator must be able to work with the business office and admissions departments to complete preliminary verification of benefits. The UM Coordinator has a working knowledge of all levels of care offered and appropriately manages client benefits.

• Manage RAE/insurance/contracts for admissions in cooperation with external stakeholders to ensure all information and processes are completed to support billing, including acquiring pre-authorization and collecting insurance information, including verifying Medicaid Eligibility.
• Provide accurate and detailed billing information in EMR, to include documenting primary and secondary insurance information.
• Ensures compliance with policies, procedures & regulations; maintains quality of records.
• Accurately enter incoming client information into electronic medical record systems.
• Distribute intake information to key individuals.
• Assists in the coordination of Involuntary Commitments and approvals for extended stays, if appropriate.
• Ensure consumers referred to Residential/Inpatient program meet the identified ASAM level of care and that pre-authorizations are approved prior to admission or prior to transfer/discharge to other levels of care.
• Accurately and concisely complete the Census Report for the end of each shift.
• Provide ongoing feedback and information on the status of admissions to clinical team members to coordinate intake and admission efforts.
• Maintain strong customer service including supporting youths and parents who may be in crisis with assistance from other JCMH staff members.
• Is an active team member including assisting in training new staff, advocating for the needs of the team with regard to best serving the clients, and identifying areas for improvement of the admission process.
• Effectively responds to the client/consumer needs and problems, initiates and maintains positive interactions with colleagues and community partners, and exhibits timely response to phone calls, email and other requests.
• Successfully completes all required training in a timely manner & attends key internal meetings as assigned.
• Follow and enforce all Jefferson Centers' Policies and Procedures, including but not limited to confidentiality, sexual harassment/harassment, dual relationships, physical and sexual abuse reporting, Corporate Compliance and Code of Ethics.

Other Duties (Productivity Performance Measures, Professional Growth/Development, Relationships/Communication):

• Participates on various interagency committees as requested by Program Manager
• Participates in supervision by coming prepared with an agenda. Reports high risk/problem cases using a problem-solving approach as well as feedback.  
• Monitors, coaches, and directs clinical team on implementing strategies to reach performance measurement benchmarks.
• Attends mandatory in-services, staff meetings, clinical supervision, and on-line training as required.
• Shares knowledge of recovery-based, stages-of-change, motivational interviewing, cognitive-behavioral, solution-focused, trauma informed and culturally competent treatment. Ensure staff adhere to the EBP programing designed to successfully treat individuals with co-occurring disorders.
• Participates in staff development activities that enhance professional growth.
• Models a trauma-informed approach by having an understanding of how trauma impacts the lives of the people being served to best ensure that every interaction is consistent with the recovery process and reduces the possibility of retraumatization.
• Ensure that delivery practices are guided by the principles of trauma informed care and the principles of addiction treatment.
• Maintains effective interpersonal relations with consumers, peers, subordinates, upper management, visitors, and the general public. Uses language and behavior to promote dignity and respect.
• Corporate Compliance including documentation on practice in accordance with regulatory requirements and clinical guidelines.
• Exhibits enthusiasm, respect, adaptability, flexibility, and spirit of cooperation in the work environment.

Note: Employees are held accountable for all duties of this job.  This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the job.

Education, Knowledge, Skills & Experience Required:

• At least 21 years of age.
• Master’s degree required. Master's degree in a related field (psychology, counseling, human services, social work, etc.) and LAC (able to be obtained within 6 months of hire) or CAS required.
• Supervisory experience preferred.
• Experience in substance use residential services as well as integrated behavioral health and/or community mental health setting preferred.
• Excellent communication skills both verbally and in writing, including computer skills. Multi-tasking abilities, adaptability to change, and demonstrated excellent customer service skills.
• Understanding of medical terminology, insurance verification, billing, inpatient medical/hospital setting preferred.
• Positive attitude, team player, and a desire to make a positive difference in the lives of adolescents and their families struggling with substance use disorders.
• Candidate must pass stringent background check including federal, state, Trails, CAPS, and Fingerprinting checks. Candidate must also pass 9 panel drug screening.

Salary Grade 14: $63,800 - $81,200*

Additional Salary Information*:

• The salary range above is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE.*

Youth Residential Recovery Bonus
$1,500 1 month anniversary
$1,500 6 month anniversary
$2,000 1 year anniversary
($5,000 Total)

Application deadline: 10/25/2024 Review of applications will begin immediately.