Corporate Intake & Utilization Manager in Franklin, TN at Acadia Healthcare

Date Posted: 7/10/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Franklin, TN
  • Experience:
    At least 3 year(s)
  • Date Posted:
    7/10/2018

Job Description

Overview

 Corporate Intake & Utilization Manager

This position provides direction and assistance to all Acadia facilities in the area of Intake/Admissions, Utilization Management and clinical services in regards to clinical documentation as it impacts a successful utilization process.  The support provided occurs both onsite and in a virtual manner. Through investigative collaboration with facility staff, the Managers’ focus in Intake is successful admission processes for regulatory compliance, a smooth patient admission experience, and completion of successful prior authorizations. The Managers’  focus on UM includes process, challenges and outcomes as it pertains to ongoing authorization, denial and appeal management and prevention, payer analysis, data metric collection and strategic planning based on the data collected.   The Manager identifies root causes and trends for adverse Intake and Utilization outcomes. Monitors the implementation of planned modifications and enhancements following site visits. Collaborates and coordinates with corporate operations and clinical partners to optimize reimbursement outcomes.

Responsibilities
  • Provides on-site and virtual assessment and analysis of current Intake and Utilization processes, challenges and outcomes.
  • Performs facility audits of clinical and financial information related to denial management including length of stay, medical necessity documentation, precertification, concurrent authorizations, compliance with Medicare Certification/Recertification, Medicare Internal Audits, and compliance with EMTALA standards.
  • Determines causation and trends for upfront denials, concurrent review denials, and failed appeals, providing written findings and recommendations for process improvement. 
  • Works in cooperation with assigned divisions to ensure that facility financial operations efforts are maximizing reimbursements while reducing unfunded days.
  • Provides monthly Divisional denial report to the Corporate Intake and Utilization Director with plan of action specific to focus facilities. 
  • Provides consultation and guidance regarding written level of care guidelines for a variety of payors.
  • Reviews clinical documentation from denied days or admissions against criteria to determine if documentation is adequate for requested treatment.
  • Provides consultation and guidance regarding the appeal process. Assists facility UM staff in creating effective appeal letters.
  • Provides group and individual training in person and via web conferencing on a variety of related topics.
  • Creates and maintains reference tool and resources for Intake and Utilization staff.
  • Ensures proper use of Medhost, the Medhost dashboard, and Salesforce.
  • Evaluates actual Intake and Utilization operations for compliance with mandatory policy, procedures, and regulatory requirements such as EMTALA.  
  • Maintains current knowledge of applicable regulations and regulatory update in the behavioral health field.
  • Evaluates the facility interface between Admissions/Intake, UR, Clinical, Business Office, and Marketing. Identifies opportunities for improved partnerships and outcomes for the facilities.
  • Provides individual training on assessment techniques and effective documentation for psychiatric and substance use disorders.
  • Provides training on eligibility verification.

Job Requirements

  • Bachelor’s degree in Nursing or other clinical degree.
  • At least 3 years’ experience in Intake and Utilization Management/Review or Case Management.
  • Good knowledge of payor clinical guidelines; experience writing appeal letters.
  • Significant behavioral healthcare experience in a variety of settings.
  • Knowledge of insurance billing requirements.
  • Ability to travel up to 75%.