Description
MENTOR Adult Day Health, a member of the Sevita family, provides day programs for elders with complex medical or rehabilitative needs. This allows seniors to obtain quality healthcare while remaining active and involved in the community and continuing to live in their own homes. Our programs are staffed with qualified, experienced licensed nurses and caregivers who are trained to provide individual assistance to each person we serve.
Program Administration Utilization Review Coordinator
Do you have experience in Title XIX program rules, regulations, and limitations, and want to join a company that positively impacts the lives of the many individuals it serves? In the Program Administration Utilization Review Coordinator role, you will contribute to the company's commitment to serve others by ensuring adherence to Title XIX waiver regulations/limitations and managed care authorizations.
- Assist in the collection of service provisions and current service information for upcoming team meetings or service change review meetings
- Conduct service authorization reviews and receive confirmation from program supervisor(s) for approval of all pending and final service authorizations
- Provide analysis to assure that service delivery corresponds with service support hours and units, staff hours and assignments, payroll hours and billing tickets, etc.
- Effectively track/assure that current and approved Individual Service Plan(s) appropriately correspond and match areas of support services and service delivery documentation records
- Maintain incoming service delivery documentation and corresponding billing tickets/pre-invoice received for processing in the regional office
- Establish and monitor the regional office/storage filing systems to assure information is organized, complete, and retrievable
- Actively engage in on-going communication with AR coordinators and/or AR accountants to facilitate timely resolution to outstanding issues and items pending payment for services provided to customers
- Assist 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
- Assure and maintain functional knowledge base and materials related to current and new funding rules and contracts
- Assist Utilization Specialist in recruiting, screening, and evaluation of personnel
- Make recommendations for hire; conduct initial/on-going in-service, certification, and training; oversee/evaluate work
- High School diploma or equivalent
- Minimum 1 year of experience working with Title XIX waiver program rules, regulations, and limitations
- Ability to manage/prioritize multiple tasks
- Excellent Excel Skills and Knowledge
- Effective communication skills and well-developed problem-solving skills
- Exceptional attention to detail and a commitment to quality in everything you do
- Foster culture of continuous improvement
- Full compensation/benefits package for employees working 30+ hours/week
- 401(k) with company match
- Paid time off and holiday pay
- Complex work adding value to the organization's mission alongside a great team of coworkers
- Enjoy job security with nationwide career development and advancement opportunities
Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized supports that lead to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face. We've made this our mission for more than 50 years. And today, our 40,000 team members continue to innovate and enhance care for the 50,000 individuals we serve.Equal Opportunity Employer, including disability/vets
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