Job Code: UMUR - 121
Revision Date: Dec 21, 2018
$25.93 - $42.41 Hourly
$2,074.40 - $3,392.80 Biweekly
$53,929.00 - $88,222.00 Annually
We are an agency committed to innovative behavioral health services in trauma-informed care that promote healing and recovery to instill a sense of empowerment and foster a lifelong sense of resilience.
The purpose of this job is to coordinate, implement, and manage the Utilization Management program which includes Prior Authorization, Utilization and Concurrent Review. The Utilization Management program collaborates with the Medicaid Managed Care companies, Medicare Advantage, and other third-party insurance companies and their providers. The UMUR Manager promotes the clinical quality and cost effectiveness of prior authorization and concurrent review functions. Also responsible for the evaluation of the appropriateness services and ensuring medical necessity is warranted, facilitates evidence-based criteria or guidelines, and under the provisions for the applicable health plan.
This class works independently, under limited supervision, reporting major activities through periodic meetings.
Duties and Responsibilities
The functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position as necessary.
Minimum Education and Experience Requirements
Requires a Master's Degree in Psychology, Behavioral Health, Business, Nursing, or Public Administration supplemented by four (4) years of experience in behavioral health, hospital administration or closely related field; or possession of any equivalent combination of education, training, and experience which provides the requisite knowledge, skills, and abilities.
Experience with trauma-informed services; cognitive behavioral therapies, including DBT; and motivational therapies including the use of incentives, preferred.
Required Knowledge and Abilities
Knowledge of trauma-informed theories, principals, and practices (includes multi-faceted understanding of concepts such as community trauma, intergenerational and historical trauma, parallel processes, and universal precautions), preferred.
Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.
Unavoidable Hazards (Work Environment)
Special Certifications and Licenses
Americans with Disabilities Act Compliance
Emergence Health Network is an Equal Opportunity Employer. ADA requires Emergence Health Network to provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with management.
Other Job Characteristics
Note: This Class Description does not constitute an employment agreement between the Emergence Health Network and an employee and is subject to change by the Emergence Health Network as its needs change.