Utilization Review Coordinator

Description: This position is responsible for carrying out daily functions related to the administration of service authorization for eligible individuals. Must strive to meet the Agency mission and exemplify the Agency’s core values.

Education: High School diploma or GED. Associate’s and/or bachelor’s degree in business, accounting or related field from an accredited college or university preferred.

Experience: Three (3) years of verifiable paid field-related experience implementing/maintaining electronic billing, bookkeeping, financial spreadsheets, utilization review or other similar electronic processes.

Skills: Must pass excel normal user test. Operate job related equipment including the use of basic computer programs and systems. Read, understand, and communicate information and ideas presented in writing. Use mathematics to solve problems. Assess and analyze information; analytical thinking. Knowledge: Maintains current knowledge of Medicaid service authorization rules. Knowledge of current trends/practices in managed care environment. Demonstrate understanding of statistical analysis and numerical calculations required. Demonstrate proficiency in Excel, Job Router, Brittco and Data Entry software computer programs required. Administrative and clerical procedures and systems such as word processing, managing files and records, preparing meeting minutes, designing forms, and other office procedures and terminology. General principles and objectives of information technology systems and programs. Proper spelling, grammar, punctuation, and sentence structure to ensure that written materials prepared and reviewed are complete, succinct, and free of errors. Abilities: Must be detail oriented. Ability to adapt to change. Enter data, generate reports, copy, manage and track documents and information. Effectively manage time to meet operational needs and desired outcomes and plan and organize the steps to implement new projects. Listen to, understand and communicate information and ideas. Work independently with minimal supervision. Maintain strict confidentiality. Work as part of a team and work effectively with people and communities from diverse cultural, social, and ethnic backgrounds. Work effectively under pressure. Other Expectations: Report unusual incidents and major unusual incidents. Completes all required training and maintains strict confidentiality. Regular attendance is mandatory. Remote / flexible work location eligible up to 80% of the time, subject to operational needs and organizational procedures. Maintain related records in accordance with appropriate records retention guidelines and policies. Adhere to health and safety policies and procedures

Summary: Collects, measures and analyzes data related to the process for approval/denial of service authorization and payment as per instruction. Enters relevant data into the software system pertaining to the process for authorization of services (includes all local and statewide systems). Completes statistical/monitoring activities for the Utilization Review process. Generates individual and aggregate utilization reports in a variety of formats, as needed. Conducts pre- and mid-ISP span utilization reviews and recommends eliminating, reducing, or increasing authorizations, as applicable. Develops proposals and/or makes recommendations to the Medicaid Services Manager regarding utilization issues, trends/patterns, and process. Complies with all Summit DD, Ohio Department of Developmental Disabilities DODD) and Medicaid related standards, rules, regulations and practices. Must follow safety and health rules and regulations, including, but not limited to, OSHA standards. Performs other related duties as assigned. Regular attendance of five (5) days per week is an essential function of this position.