Intake Specialist - MH & SUDS

Company: UCare
Location: Minneapolis
Posted on: March 19, 2023

Job Description:

ABOUT UCARE UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives. WORKING AT UCARE Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job. Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 13 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities. INTAKE SPECIALIST - MH & SUDS Work Location: Work from home The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons. Position Description This position is responsible to receive and process authorization requests or admission notifications from providers/physicians, case managers, vendors, and facilities.Provide assistance and oversight in tracking of requests or reports to meet regulatory guidelines in identified areas. Perform data entry in support of the review activities of each business unit in the department. Provide live telephonic access for external and internal customers. ---Receive prior authorization and notification requests for mental health and substance use disorder services. Evaluate request to determine appropriate review entity and provide assistance with the continuum of utilization management review process. Initiate and complete notification reviews, issue organization determinations including approvals and dismissal denials, as well as preparing and routing service requests to utilization management staff for review as appropriate.---Monitor and retrieve admission notification and service requests received through identified fax lines, US mail, and voicemails.---Support the urgent concurrent determination process by ensuring compliance with regulatory guidelines through completing initial approval notification for admissions and conducting follow-up with providers to prepare for concurrent utilization review.---Coordinate the care of services and providers to avoid duplication. Provide education to all change of provider processes. ---Ensure timely and accurate entry of data within established turnaround times. Communicate and coordinates with other UCare departments and external providers to obtain information, request action or follow-up.---Promptly answer incoming department calls for external and internal customers during regular business hours. Respond to provider or vendor inquires as it relates to MSS programs and services and triage to other teams as needed.---Document all pertinent calls/interactions using established department standards.---Facilitate, distribute, and monitor regulatory reports to facilities and providers, i.e., IMD follow up and reporting. Follow-up with identified issues with an initial phone call or electronic communication for status checks.Escalating any trends/ongoing issues with facilities to leadership as necessary. ---Understand, implement, and support the Evidence of Coverage (EOC), Certificate of Coverage (COC), organizational policies, department procedures and protocols; published authorization grids, medical policies, review criteria, review standards and regulatory requirements relative to the MSS intake process. ---Other projects and duties as assigned. Education Two-year degree or diploma in health or ancillary care. Demonstrated experience may be considered in lieu of degree. Required Experience Three years experience in data entry and/or telephonic customer service in productivity-based environment. Experience with mental health and substance use disorder population. Use and understand medical and mental health/substance use disorder terminology, CPT, ICD-10 coding and commonly used electronic business office tools. Preferred Experience Experience with insurance operations, member or provider customer service, and experience in Managed Care. Experience with hospital, clinic, or other health care facilities/providers. THE UCARE DIFFERENCE The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve. JOB POST DATE: 2/22/2022

Keywords: UCare, Minneapolis , Intake Specialist - MH & SUDS, Other , Minneapolis, Minnesota