Administrator of Utilization Management

If you are interested in a career in behavioral healthcare that blends clinical expertise, data analysis, and collaboration across programs to ensure individuals receive the right level of care at the right time, this may be the position for you Under the oversight of the Director of Quality Management, the Administrator of Utilization Management supports access to services, compliance with State, Federal, and funding source requirements, and continuous improvement by working closely with Tri-County Behavioral Healthcare (TCBHC) leadership, the Quality Management team, and external partners to guide utilization practices across the Center.

What you'll do

• Serve as the Center's Utilization Manager and support compliance with the Center's Utilization Management Plan and applicable State, Federal, and contract requirements.
• Works closely with Quality Management and program staff, as needed, to address the appropriateness of eligibility determinations, level of care assignments, authorization and reauthorization processes, and utilization trends.
• Run, analyze, and validate key reports to support performance improvement when indicated.
• Conduct manual chart reviews as needed.
• Monitor trends related to over and under utilization, fairness and equity, medical necessity, and cost effectiveness of services.
• Co-facilitate Quality and Utilization Management meetings in collaboration with the Administrator of Quality Management, lead the Junior Utilization Management Committee and represent the Center, as requested, in Regional and State Utilization Management initiatives.
• Oversee the Center's appeals process and coordinate and attend Medicaid Fair Hearings on behalf of the Center, when needed.
• Effectively manages the Center's Risk Stratification process.
• Collaborate with Information Technology, Quality Management, and program staff to improve data accuracy, reporting tools, and utilization-related processes.
• Serve as back up to the Quality Management Department and participate in both internal and external audits, as needed.

Work Location

This position is office based, with the potential for remote work in the future based on operational needs and performance.

You're a good fit if you...

• Are professional, flexible, organized, and detail-oriented
• Communicate clearly and effectively, both verbally and in writing
• Provide excellent customer service and problem-solving support
• Can exercise independent judgment while collaborating with leadership
• Understand confidentiality requirements and accountability expectations
• Leadership experience is a plus, including the ability to provide guidance and direction across multiple programs and collaborate effectively with supervisors and directors

What you'll need

• Master's Degree from an accredited four-year college
• License qualifying as a Licensed Practitioner of the Healing Arts (i.e. LPC, LCSW, LMFT).
• • May consider candidates who will complete full licensure within 1-2 years (i.e. LPC-A, LMSW, LMFT-A) at a lesser salary.
• Quality or Utilization Management Experience preferred.
• Ability to pass basic Microsoft Word and Excel competency testing
• Typing speed of at least 40 WPM
• Valid driver's license and ability to be insured through Tri-County
• Reliable transportation

What's in it for you

• Awesome Benefits for you and your family
• Medical, Dental, Vision, Short-Term Disability, Company-paid Life and Disability insurance, HSA/FSA
• Retirement Options with Company Match
• Mental health and wellness support from our Employee Assistance Program
• Financial Wellbeing
• Say goodbye to those pesky loans- we're a Federal Student Loan Forgiveness qualified employer
• Weekly Pay deposited directly into your