Utilization Manager - 130702

About Claratel Behavioral Health

Claratel Behavioral Health is an innovative, community-based behavioral health and developmental disabilities services organization offering a full range of mental health, developmental disabilities, and substance use disorder services to underserved individuals. As a public, not-for-profit organization, Claratel Behavioral Health operates in more than 20 locations in DeKalb County, Georgia, with a diverse workforce of more than 400 direct-care and support staff.

If you are passionate about driving change in behavioral health and developmental services and are eager to work in an environment that values innovation and inclusivity, Claratel Behavioral Health is the place for you. Here, your work is impactful, your growth is prioritized, and your well-being is supported. Together, we can forge pathways to a healthier future for all.

Utilization Management Manager

Location: Claratel Winn Way- 445 Winn Way, Decatur, GA 30030

Hours: Monday – Friday 8:00am- 5:00pm (Hybrid)

Claratel Behavioral Health is seeking a dedicated and experienced Utilization Management Manager to oversee the UM functions and ensure appropriate authorization for behavioral health services across the agency.  This role oversees the day-to-day functions of operations of utilization review including initial authorizations, concurrent reviews, reauthorizations, and appeals management. The UM Manager collaborates cross-functionally with clinical, billing, compliance, and digital strategies to optimize authorization workflows and ensure quality, coordinated care.

Key Responsibilities:

• Supervise staff to coordinate/manage authorization process for Medicaid, CMOs, and State payers.
• Track authorization pends and provides feedback to clinical staff and supervisors regarding utilization trends.
• Assist with denials and provide assistance to clinical staff and supervisors regarding the appeal process and utilization expectations.
• Provide training to clinical staff to improve authorization documentation
• Assist with the development of technical plans which would enable the agency to prepare for possible changes in managed care.
• Provide technical assistance and advice in developing, implementing, and improving clinical programs.
• Customer Support: Responding to phone calls and emails from Clinical Staff
• System Error Coordination: Analyze and problem solve issues with current and planned systems as they relate to the integration and management of client data
• Service Corrections
• Duplicate Client records in EHR
• Documentation Errors
• Implement State Reporting Changes related to authorization in the EHR system
• Reports Prepared and Distributed to the appropriate staff
• AD Hoc Reporting
• EHR system automated reporting

Skills and Competencies:

• Experience with healthcare information systems and software

• Proficiency in data analysis and report generation

• Excellent analytical and problem-solving skills, with the ability to interpret complex healthcare data and identify trends and patterns.
• Exceptional communication and interpersonal skills, with the ability to liaise effectively with diverse stakeholders, including medical staff, insurance providers, and regulatory agencies.
• Proficient computer skills, including experience with electronic health record systems and Microsoft products.
• Demonstrated leadership abilities, with the capacity to motivate and inspire a team towards achieving organizational goals.
• Strong attention to detail and ability to adhere to strict confidentiality guidelines.
• Demonstrated ability to work independently and manage multiple priorities in a fast-paced environment.

Preferred Experience:

• 3-5 years of utilization management experience in a healthcare setting, with at least 2 years in behavioral health
• 2+ years of experience in a supervisory or management role
• Preferred but not required: Licensed Professional Counselor (LPC) or equivalent with at least 2 years of clinical experience.