Medicaid Utilization Review Specialist

Job Summary:

The University of Colorado Anschutz Medical Campus is seeking a Medicaid Utilization Review Specialist (full time, University Staff/Non classified) in the Department of Psychiatry. The residential program, Inspiration for Men is located in Denver Colorado on the Fort Logan Campus. The residential treatment program is a short-term Medicaid funded program treating adult men with a substance use disorder and other co-occurring diagnosis. This position will support management in tasks related to gathering information from the clinical team and presenting to Medicaid if medical necessity is needed for continued treatment and/or discharge planning should occur. The position duties require quality assurance and compliance of Medicaid and Behavioral Health Administration (BHA). This position is also responsible for understanding Medicaid compliance rules.

The ARTS Inspiration for Men program provides residential treatment services to men. Inspiration for Men is a Medicaid funded program and provides up to 90-day residential stays for men suffering from severe substance use and co-occurring mental health disorders. The program provides drug and alcohol assessment, psychosocial and pharmacological treatment, psychiatric services, and medication management.

This position will report to and serve under the supervision of the Program Director. This position is responsible for managing various aspects of patient Medicaid authorization for residential treatment based on ASAM level of care. 

Key Responsibilities:

• Collaborate and set standards to ensure that all patients have the correct admission status, so that the appropriate claim can be submitted.
• Evaluate patient Medicaid issues presented from Clinical counselor(s) prior to ASAM documentation due to Medicaid.
• Perform other concurrent and retrospective reviews with 2-4 business days or earlier as directed by Program Director.
• Participates in weekly clinical team meetings and actively participates in process improvement initiatives. This includes collaborating with staff to answer clinical questions related to medical necessity and patient status.
• Identifies, develops, and provides orientation, training and competency development for appropriate staff and colleagues on an ongoing basis.
• Serve as resource person to ensure consistent and accurate patient status determinations for appropriate claim submission. Including, assisting with preparation of discussion and appeal letters for Medicaid medical necessity denials.
• Review, process and audit the medical necessity for each patient behavioral health treatment and documentation Medicaid authorization.

Work Location:

Onsite – this role is expected to work onsite and is located on the Fort Logan campus in Denver, CO. Some hybrid work may be considered dependent on program needs.

Why Join Us:

Addiction Research and Treatment Services (ARTS) is the clinical program of the Division of Substance Dependence, Department of Psychiatry at the University of Colorado, School of Medicine. ARTS has provided residential and outpatient empirically supported substance abuse treatment services in Colorado for over 45 years, with an emphasis on psychosocial and pharmacological treatments for adolescents, women, men, families, and those involved in the criminal justice system. It is the mission of ARTS to improve the quality of life and productivity of individuals and families affected by substance use and co-occurring mental health disorders through the application of scientifically supported prevention, education, and treatment services.

The University of Colorado Anschutz Medical Campus is a public education, clinical and research facility serving 4,500 students, and a world-class medical destination at the forefront of life-changing science, medicine, and healthcare. CU Anschutz offers more than 42 highly rated degree programs through 6 schools and colleges and receives over $500 million in research awards each year. We are the single largest health professions education provider in Colorado, awarding nearly 1,450 degrees annually. Powered by our award-winning faculty, renowned researchers and a reputation for academic excellence, the CU Anschutz Medical Campus drives innovation from the classroom to the laboratory to the delivery of unparalleled patient care. Read CU Anschutz Quick Facts here.

The University of Colorado offers a comprehensive benefits package that includes health insurance, life insurance, retirement plans, tuition benefits, ECO pass, paid time off – vacation, sick, holidays and more. To see what benefits are available, please visit: https://www.cu.edu/employee-services/benefits-wellness .

Diversity and Equity:

The University of Colorado Anschutz Medical Campus is committed to recruiting and supporting a diverse student body, faculty, and administrative staff. The university strives to promote a culture of inclusiveness, respect, communication and understanding. We encourage applications from women, ethnic minorities, persons with disabilities, persons within the LGBTQ+ community and all veterans. The University of Colorado is committed to diversity and equality in education and employment.

Qualifications:

Minimum Qualifications:

• A bachelor’s degree in health, human services, psychology, counseling, social work, or a directly related field from an accredited institution.
• CAS (certified addiction specialist) certification.
• One (1) year of Medicaid/insurance specialist experience in any aspect of the revenue cycle process in healthcare. (Patient registration, billing, prior authorizations etc.).

Applicants must meet minimum qualifications at the time of hire.

Preferred Qualifications:

• Three (3) or more years of experience with insurance verification, financial counseling, patient financial services, patient registration in the behavioral health field.
• Two (2) years of experience in the SUD field.
• Licensed as LCSW, LPC, LMFT, or PsyD.
• Experience with insurance verification and authorization.
• Experience using Electronic Health Record and Patient Health Information management systems.

Knowledge, Skills, and Abilities:

• Well-developed knowledge and skills in areas of utilization management, medical necessity, and patient status determination.
• Ability to establish and maintain effective working relationships with employees at all levels throughout the institution.
• Applies critical thinking and conflict resolution skills using creative approaches.
• Knowledge of approved status determination criteria apply consistently according to inter-rater reliability techniques.
• Attention to detail.
• Strong organizational and time management skills.
• Excellent writing and editing skills.
• Ability to work with diverse patient population, providers, and staff.
• Ability to comply with established rules, policies and procedures and meet deadlines.
• Ability to be nonjudgmental and respectful of other’s beliefs, values, and culture.
• Effectively and efficiently manages a diverse workload in a fast-paced, rapidly changing regulatory environment.
• Proficient in Microsoft Office programs and ability to learn software programs.

How to Apply:

For full consideration, please submit the following document(s):

1.     A letter of interest describing relevant job experiences as they relate to listed job qualifications and interest in the position.

2.     Curriculum vitae / Resume

3.     Three to five professional references, including name, address, phone number (mobile number if appropriate), and email address.

Questions should be directed to: Irene Arguelles, [email protected]

Screening of Applications Begins:

Screening of applications begins immediately and continues until position is filled.

Anticipated Pay Range:

The starting salary range (or hiring range ) for this position has been established as $56,358 - $71,688.

The above salary range (or hiring range ) represents the University’s good faith and reasonable estimate of the range of possible compensation at the time of posting. This position may be eligible for overtime compensation, depending on the level.

Your total compensation goes beyond the number on your paycheck. The University of Colorado provides generous leave, health plans and retirement contributions that add to your bottom line.

Total Compensation Calculator: http://www.cu.edu/node/153125

ADA Statement:

The University will provide reasonable accommodations to applicants with disabilities throughout the employment application process. To request an accommodation pursuant to the Americans with Disabilities Act, please contact the Human Resources ADA Coordinator at [email protected] ​.

Background Check Statement:

The University of Colorado Anschutz Medical Campus is dedicated to ensuring a safe and secure environment for our faculty, staff, students, and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees.

Vaccination Statement:

CU Anschutz strongly encourages vaccination against the COVID-19 virus and other vaccine preventable diseases . If you work, visit, or volunteer in healthcare facilities or clinics operated by our affiliated hospital or clinical partners or by CU Anschutz, you will be required to comply with the vaccination and medical surveillance policies of the facilities or clinics where you work, visit, or volunteer, respectively. In addition, if you work in certain research areas or perform certain safety sensitive job duties, you must enroll in the occupational health medical surveillance program .