Utilization Review CoordinatorApply Now Job ID 17000LIF
Utilization Review Coordinator
Primary Location: MA-MABrighton-1284 Soldiers Field Rd
Function:Program Services Coordination/Case Management
Revel Adult Day Health is looking for an individual who is caring and committed to adult and elders' wellbeing.
Every person needs the support of others, but we look for very special people to support the seniors and adults we serve. As a Utilization Review Coordinator (URC) with Revel Adult Day Health, you’ll be one of those special people. Serving as a URC, you can have an amazing impact in the quality of services for the adults and families we support as you work to insure our program meets our members’ individual needs. Be part of a strong team making a difference in their lives each day. For Revel and The MENTOR Network, a URC is critical to our success and exemplifies the wonderful mission driven work we do here every day.
Revel Adult Day Health is seeking a dynamic and passionate person to serve as Utilization Review Coordinator and provide assistance in ensuring adherence to Title XIX Waiver regulations/limitations and managed care authorizations. Additionally, assists in enhancing quality assurance measures as evidenced by increased compliance with applicable regulations and may also coordinate and distribute workflow for assigned staff.
Specific tasks include:
- Assists in collection of service provision (planned, actual, over utilized) and current service information for program supervisor(s) for upcoming team meetings or service change review meetings.
- Conducts Service Authorization reviews and receives confirmation from program supervisor(s) for approval of all pending and final service authorizations.
- Provides analysis to assure that service delivery (planned to actual) correspond in areas of service support hours and units, staff hours and assignments, payroll hours and billing tickets, etc.
- Effectively tracks and assures that current and approved Individual Service Plan(s) appropriately correspond and match areas of support services and service delivery documentation records.
- Responsible for daily coordination and tracking systems of incoming service delivery documentation and corresponding billing tickets/pre invoice received for processing in the regional office. Performs weekly, bi-weekly, and monthly reviews and verifies completeness of required information. Reports status of various service delivery targets and projects outcomes to supervisor.
- Establishes and monitors the regional office and storage filing systems to assure information is organized, complete, and retrievable for compliance audit file reviews.
- Actively engages in on-going communication with AR coordinators and/or AR accountants via phone, email, group meetings, etc. to facilitate timely resolution to outstanding issues and items pending payment for services provided to customers.
- Assists in communication with Interdisciplinary Planning Teams to address areas of identified errors, corrections, or needed services related to billing units and over/under utilization areas.
- Assures and maintains functional knowledge base and materials related to current and new funding Rules and Contracts, provides updates and information to supervisor and/others specific to impact on service delivery, authorizations, and utilization of services.
- Assists Utilization Specialist in recruiting, screening and evaluation of personnel. Makes recommendations for hire; conducts initial and on-going in-service, certification, and training; and oversees and evaluates work.
What we offer you:
- ·A chance to make a difference in peoples’ lives on a daily basis
- ·A rewarding work environment with some of the best co-workers you could ask for
- ·Competitive pay rates and paid time off
- ·Paid training; Holiday pay
- ·Family-oriented environment, employee events
- ·Career development and advancement opportunities
- ·A dynamic work environment where no day is ever the same as the next
What we require of you:
- ·High School Diploma or equivalent
- ·One year experience working with Title XIX Waiver program rules, regulations, and limitations.
We have a great work environment and you’ll be surrounded by a strong and supportive team of peers, leaders and colleagues. Revel Adult Day Health is a partner of The MENTOR Network. Founded in 1980, The MENTOR Network is a national network of local human service providers offering quality, community-based services. With approximately 30,000 employees serving 26,000 consumers in 35 states, you'll have career opportunities from coast to coast. When you join The MENTOR Network, you’ll make a difference every day and help to provide quality of life enhancing services to individuals across the country.
Come join our team of dedicated and caring professionals. Apply Today!