Utilization Management Specialist

About Altior Healthcare

Our family of services comprises three distinct mental health treatment programs, including a specialized program for US Veterans. With over 15 unique locations, we manage and support 500+ dedicated employees serving over 300 residential clients daily located across five states: California, Idaho, Maine, New Hampshire, and Texas.

Paradigm Treatment (West Coast) and Ridge RTC (East Coast) partner together under Altior, united by a shared commitment to providing exceptional mental health care. For over a decade, our core clinical and support teams have worked side-by-side, delivering compassionate, evidence-based treatment that changes lives.

As part of the Altior network, you'll find the stability of an established organization with the heart of a close-knit treatment community where every role matters.

Job Summary

The Utilization Management Specialist is responsible for directing and overseeing the reporting of utilization statistics and trends, consulting with all services to ensure the provision of an effective treatment plan for all patients, and interfaces with managed care organizations, external reviewers, and other payers.

Responsibilities

• Advises clinical team of documentation necessary to successfully advocate for admission and continued to stay at the most appropriate level of care.
• Utilize clinical information and knowledge of Behavioral & Mental Health Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
• Collaborates with the Admissions and Billing departments for the purpose of supporting and improving the commercial insurance authorization process.
• Maintain logs and databases for utilization management, fiscal management, care coordination activities, and performance improvement measures.
• Conduct prospective, concurrent, and retrospective reviews as required by networks, utilizing telephonic information, medical records, and/or faxed medical information and establish single cases as necessary.

Qualifications

• Previous experience with Utilization Review.
• Previous experience within the field of mental health or behavioral health.

Benefits

• Comprehensive benefits package: medical, dental, and vision.
• 401k with 4% match.
• Paid Time Off Programs including vacation, holidays, and illness.

For Direct Care roles:

• Chef made meals onsite.
• Professional trainings provided for development; continuing education assistance for clinicians.
• Supportive clinical supervision and professional development.

Altior Healthcare is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law.

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