Utilization Review Specialist

Intercept Youth Services Richmond , VA 23234

Posted 9 months ago

Utilization Review Specialist

Full-Time/Salaried/Exempt

SUMMARY:

Completes assigned Medicaid submissions related to pre-authorization, re-authorizations, and discharge notifications for those Medicaid eligible individuals receiving services in the Community Homes. Communicates information effectively between Magellan and Community Homes. Travels to weekly treatment team meetings for assigned programs. Conducts compliance review to assist the program in identifying concerns with state and federal regulatory standards, as well as Intercept's policies and procedures.

Medicaid Pre-Authorization

  • Interfaces with Admission Coordinators in obtaining required documentation as preparation for initial Medicaid submissions.

  • Organizes the transmission and exchange of information and documentation associated with pre-authorization.

  • Maintains accurate records of all material submitted as part of pre-authorization.

  • Coordinates and facilitates appeals to Magellan as needed.

Medicaid Re-Authorization

  • Interfaces with Clinical and Program Managers in obtaining required documentation in preparation for re-authorization of Medicaid payments.

  • Organizes the transmission and exchange of information and documentation associated with re-authorization.

  • Maintains accurate records of all material submitted as part of re-authorization.

  • Coordinates and facilitates appeals to Magellan as needed.

  • Participates in weekly treatment team meetings for assigned programs.

Medicaid Discharge Notifications

  • Interfaces with Clinical and Program Managers in obtaining required documentation in regards to recommended aftercare services.

  • Organize the transmission and exchange of information and documentation associated with discharge.

  • Maintains accurate records of all material submitted as part of discharge.

  • Performs any other duty which may be requested but not included herein.

Compliance for Community Homes

Utilize and maintain current knowledge of all state and federal regulatory standards and Intercept policies and procedures to support compliance of assigned community home.

EDUCATION AND /OR EXPERIENCE

Bachelor's degree in related field required; experience with Magellan's authorization process desired


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Utilization Review Specialist

Intercept Youth Services