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Utilization Review Care Manager (LPC, LADC, LMFT, LCSW, or RN) - Ambulatory Administration

Requisition ID:

22165094

Business Unit:

Hartford Hospital

Location:

Hartford, CT

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Description

Job Schedule: Full Time
Standard Hours: 40
Job Shift: Shift 1
Shift Details:

Work where every moment matters.

Every day, almost 30,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment matters here.  We invite you to become part of Connecticut’s most comprehensive healthcare network. 

The Institute of Living, one of the first mental health centers in the U.S., remains one of America’s leading not-for-profit centers for patient care, research and education in the fields of behavioral, psychiatric and addiction disorder. Through our dedicated, experienced and skilled clinicians, we provide patients and their families with the highest quality of personalized care. Programs are offered for children, adolescents and adults struggling with mental illness as well as offering services specializing in Anxiety, Eating Disorders, and Geriatric Services.

Job Summary

Coordinates the care of clients in collaboration with clinical program staff.  Liaison with insurance companies and other referral sources.  Obtains level-of-care authorizations from managed care companies when clinically necessary. Requires in-depth knowledge of behavioral health services in order to accurately articulate and advocate for patient’s care requirements and effectively obtain authorizations. Ensures that authorizations are current and documented as required. 

Job Responsibilities

  1. Obtains level-of-care authorizations from managed care companies when clinically necessary. Requires in-depth knowledge of behavioral health services in order to accurately articulate and advocate for patient’s care requirements and effectively obtain authorizations.
  2. Accurately inputs information into Medical Record System to ensure authorizations are complete. Error or omissions here may result in loss of payment.
  3. Collaborates with the payor source and the primary clinician/treatment team and refers clients to appropriate level of care, based on symptomatology and benefit structure.
  4. Ensures client admission, continued stay, and discharge meet the criteria of the program.
  5. Communicates with referral sources to determine benefits and pre-certify admissions.
  6. Maintains records and prepares statistical reports as assigned. Enters data into business software and other business systems as required.
  7. Assists with process of appeals as directed by the Manager – Utilization Review.
  8. Performs other duties as assigned.

Qualifications

  • Bachelor's degree with 5 years' experience in a behavioral health setting
  • Master's degree preferred with 3 years' experience in a behavioral health setting
  • Documented assessment skills of the biopsychosocial needs of behavioral health clients
  • LPC, LADC, LMFT, LCSW, or RN
  • Computer proficiency and keyboard skills required
  • Ability to read and understand oral and written instructions and effectively communicate information
  • Work is performed in accordance with instructions and procedures, but incumbents must organize the work, set priorities, exercise discretion and evidence good clinical and social judgment
  • Must be able to perform assigned duties promptly and consistently.
  • Must be able to maintain confidentiality and comply with applicable HIPPA and regulatory requirements at all times.
  • Must be able to acquire a thorough knowledge of third party payor requirements as well as hospital registration and billing processes.
  • Excellent interpersonal skills necessary to communicate with departments, employees, physicians, managers, patients, families, referral sources and managed care organization representatives.
  • Ability to manage time and meet deadlines in a hectic work environment.  
  • Ability to handle multiple priorities.
  • Working knowledge of Windows-based software applications.

We take great care of careers.

As a Hartford Healthcare entity, The Hartford Hospital Institute of Living provides eligible employees with an extensive benefits package and all the benefits of working in a thriving centrally located urban community:

  • Medical and dental benefits
  • 401(k) plan with employer match
  • Generous paid time off with accrual starting on the date of hire
  • Additional voluntary benefits as well as employee discount programs
  • Located on the Institute of Living’s historic park-like grounds designed by Frederick Law Ohlmsted

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth.  Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children.  We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance.  Every moment matters.  And this is your moment.

 
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