An exciting job opportunity for an Utilization Manager at Abraxas Ohio has just become available in Shelby, Ohio.

Looking for a way to make an impact and help people? Here, you will be part of a team helping others BUILD BETTER FUTURES.

In this role, you are responsible for management of all utilization review/case management activities for the facility’s inpatient, partial hospitalization, and outpatient programs.

To be successful in this role, you will think critically, and tackle ambiguity and complex problems effectively and efficiently.

Abraxas Ohio

2775 State Route 39

Shelby, Ohio 44875

Compensation: $55,000 Annually

Schedule: Monday to Friday 9:00 AM to 5:00 PM

Who We Are:

Abraxas Youth & Family Services is a national nonprofit human services provider dedicated to Building Better Futures for at-risk youth, adults, and families. Our diversified array of services includes alternative education, outpatient counseling, in-home services, shelter, detention, residential treatment and re-entry/transition services.

Since 1973, Abraxas team members have positively impacted the lives of those we serve and the communities in which they live.

Benefits & Perks:

We provide a competitive and comprehensive benefits program that offers the protection, peace of mind and flexibility designed to support you – both at home and at work.

• Medical & Dental & Vision Insurance
• Flexible Spending Accounts
• Basic Life & Short-Term Disability Insurance
• 403(b) Savings Plan
• Life Assistance Program (LAP)
• Tuition Assistance Program
• Paid Time Off (PTO) * Paid Holidays * Paid Training
• Advancement Opportunities

Utilization Manager

The position is responsible for monitoring and track concurrent reviews for timeliness and appropriate content to request additional authorization. You will assist in writing precertification requests for new admissions, monitoring and resolving eligibility issues and other health insurance issues.

Essential Functions:

• Prepares and submits prior authorizations
• Reviews and prepares concurrent reports
• Performs certification activities through continued-stay and retrospective reviews to third party payers and regulatory agencies, thus maintaining denial rates. Prepares and submits clinical appeals if and when denied
• Impacts length of stay and influences use of resources by sharing knowledge with physician practices, payers, agencies and community resources
• Monitors patients’ clinical progress and coordinates patient care from admission to discharge.
• Assist with chart audits and filing as needed
• Encourage optimum utilization of medical care, appropriate level of care and utilization of hospital beds
• Serves as resource person for members of the healthcare team, patients, and caregivers.
• Maintain current knowledge of community agencies and services, medical necessity and clinical criteria for RTC level of care including ASAM criteria
• Provides education regarding third party payers and regulatory agency requirements for reimbursement
• Attends staff meetings and participates in department activities and programs
• Independently manages an established caseload on a daily basis, assists other staff members with high/low census, provides coverage after normal working hours or weekends as facility needs indicate
• Communicates effectively with clients, support services, and co-workers; uses communication systems effectively (i.e. Communication Log, E-Mail, Shift Plans, Feedback Log, Status Recommendation Sheet, Incident Reports)
• Implements Abraxas policies on professional expectations, code of conduct and other practices and procedures
• Participates in the development of shift plans
• Maintains knowledge of each client’s problem areas

Minimum Requirements:

• Bachelor’s degree in accounting or a related field and minimum two years related experience.
• Required certifications or license: CDCA, or above. LSW, LISW, LPC, or LPCC

Other Qualifications:

• At least twenty-one (21) years of age.
• Criminal clearances (Specific State & child clearances and, if necessary, FBI).
• Non-communicable diseases physical exam, drug test
• Ability to work with computers and the necessary software typically used by the department.

Why Should You Consider Abraxas?

• At Abraxas, we celebrate the richness of our diverse employees and the communities we serve. We are actively committed to building a culture of awareness and belonging, as we strive to ensure we are a welcoming, inclusive, and culturally competent organization.

• As we work to make a difference in people’s lives, we are dedicated to respect, equity, and the engagement of those we serve and our employees.

• As a provider of trauma-informed care, we firmly believe in recovery and that our clients can lead fulfilling and meaningful lives, and we consider it an honor and a privilege to assist them in their journey.

• Whether you’re looking to begin a rewarding career or you’re a seasoned professional wanting a new challenge, we have a place for you and opportunities for development at all levels.

• At Abraxas, everything we do centers around people. That is why we are committed to providing you with competitive pay and comprehensive benefit options that help make your life easier and healthier, with a focus on providing choice when it comes to physical, emotional and financial wellness. Our benefit options meet you where you are in your life and set you up for success both in and outside of work.

• If you want to have a positive impact in the lives of others, come join us!