UM Specialist – In-Person Training

• Obtaining initial and subsequent authorizations of clinical services from insurance and government payors
• Reviewing clinical records and determining the appropriateness of patient admission, level of care, continued length of stay, and discharge
• Providing training and support to clinical treatment staff on the insurance authorization process
• Assisting staff with preparing peer-to-peer reviews and clinical appeals by advising them on presenting case information in accordance with established procedures
• Preparing regular summary reports and presentations on utilization management data
• Other duties as assigned

• Comprehensive knowledge of treatment planning and behavioral healthcare clinical documentation, therapeutic services, intervention techniques, and medical records review.
• Bachelor's degree in counseling, nursing or a closely related field.
• Master's degree preferred.
• Knowledge and familiarity with the utilization management process in order to maximize appropriate treatment as indicated by client needs and comply with regulations, policies and procedures.
• Understanding of diagnoses and ability to collect, analyze and report on utilization management data at a level normally acquired through three to five years progressively more responsible related experience in a healthcare setting.
• Proficiency in computer software applications such as Microsoft Word and Excel to complete required forms, reports, and analyses.
• Familiarity with electronic health record systems to review patient records and determine appropriateness of patient care.
• Advanced communication skills to effectively present information verbally and in writing and work collaboratively with others to establish single case agreements, identify process improvements, resolve problems and provide effective training.
• Advanced interpersonal skills necessary to provide advice and counsel to managers and employees and to gather and exchange information with a variety of internal and external contacts.
• High level analytical skill necessary to interpret insurance contracts and provisions, determine appropriateness of patient admissions and continued length of stay, and make recommendations to enhance services as needed for individual clients.
• A current and valid driver's license, in order to travel to others sites to participate in trainings and meetings.

Demonstrates comprehensive knowledge of treatment planning, behavioral healthcare documentation, and the utilization management process, with proficiency in data analysis and reporting. Capable of providing effective training and support to clinical staff while ensuring compliance with regulations and policies.

• Utilization Management Process
• Behavioral Healthcare Documentation
• Data Analysis and Reporting

• Treatment Planning
• Clinical Documentation
• Medical Records Review
• Data Interpretation
• Peer-to-Peer Reviews
• Clinical Appeals
• Insurance Authorization
• Analytical Skills
• Microsoft Word
• Microsoft Excel

• Advanced Communication
• Interpersonal Skills
• Collaboration
• Problem Solving
• Advisory Skills

• Bachelor's Degree in Counseling
• Bachelor's Degree in Nursing
• Master's Degree Preferred

• Healthcare Setting
• Insurance Contracts
• Clinical Services
• Patient Admission
• Length of Stay
• Discharge Planning

• Electronic Health Record Systems