Utilization Review Coordinator
Primary Location: CA-CARancho Cucamonga-9166 Anaheim Place
Function:Program Services Coordination/Case Management
Every person needs the support of others, but we look for very special people to support individuals with disabilities. As a Utilization Review Coordinator with California MENTOR you’ll be one of those special people.
For California MENTOR and The MENTOR Network, a Utilization Review Coordinator is critical to our success and exemplifies the wonderful mission driven work we do here every day.
To that end, the Utilization Review Coordinator role is a fantastic role to continue your career path in Social and Human Services with a myriad of career options to move up and across the organization.
California MENTOR is seeking a Utilization Review Coordinator to assist in ensuring adherence to Title XIX Waiver regulations/limitations and managed care authorizations. This individual will also assist in enhancing quality assurance measures as evidenced by increased compliance with applicable regulations. The Utilization Review Coordinator may also coordinate and distribute workflow for assigned staff.
- Assists in collection of service provision (planned, actual, over utilized) and current service information for program supervisor(s) for upcoming team meetings or service change review meetings.
- Conducts Service Authorization reviews and receives confirmation from program supervisor(s) for approval of all pending and final service authorizations.
- Provides analysis to assure that service delivery (planned to actual) correspond in areas of service support hours and units, staff hours and assignments, payroll hours and billing tickets, etc.
- Responsible for daily coordination and tracking systems of incoming service delivery documentation and corresponding billing tickets/pre invoice received for processing in the regional office. Performs weekly, bi-weekly, and monthly reviews and verifies completeness of required information. Reports status of various service delivery targets and projects outcomes to supervisor.
- Assists in communication with Interdisciplinary Planning Teams to address areas of identified errors, corrections, or needed services related to billing units and over/under utilization areas.
- Assures and maintains functional knowledge base and materials related to current and new funding Rules and Contracts, provides updates and information to supervisor and/others specific to impact on service delivery, authorizations, and utilization of services.
- Generates assigned management reporting including insightful analysis and commentary to tell the story and provide a basis for action steps.
- Builds and maintains strong relationships with members of the finance team and the business partners that we support.
- High School Diploma or equivalent and one year experience.
- Experience with Medi-CAL and/or Department of Mental Health billing and funding
- Demonstrated knowledge of Microsoft Office products
- 1-2 years' accounting experience preferred
- Experience with Hyperion, Avatar and Oracle preferred
- Demonstrated leadership ability
- Ability to effectively establish and maintain meaningful relationships
- Ability to coordinate activities and services to meet the on-going needs of individuals served
- Strong follow through to ensure quality services, regulations and clients’ rights are upheld
- High energy, goal-oriented, and an ability to inspire people
- Access to a registered vehicle with proof of insurance
- Must be at least 18 years of age
- Must pass background investigation that includes FBI/DOJ fingerprint check
What we offer you:
- A competitive compensation/benefits package including 401(k) with company matching
- Annual bonus plan
- A rewarding work environment
- Meaningful relationships with your co-workers and the individuals we serve
- Time Off & Holiday Pay
- Family-oriented environment, casual dress
- Employee discounts; fun employee events
- Dynamic work environment, no day is ever the same as the next
- On-the-job training including paid CEU opportunities, career development and advancement opportunities
- Access to jobs throughout the nation-wide Network
- Mileage reimbursement
Bring the right attitude; we’ll train you for success!
We have a great work environment and you’ll be surrounded by a strong and supportive team of peers, leaders and colleagues. California MENTOR is a part of The MENTOR Network. The MENTOR Network is a national network of local human service providers offering quality, community-based services. With approximately 28,000 employees serving 25,000+ consumers in 36 states, you'll have career opportunities from coast to coast. When you join The MENTOR Network, you’ll make a difference every day and help to provide quality of life enhancing services to individuals across the country.