Employment Type:

Shift:

Description:

Position Purpose

The Utilization Management Specialist is responsible for acute care concurrent review authorizations, denials tracking & reporting as well as appeals management. Acts as a resource and guide for physicians, the care delivery team, patients and their families throughout the continuum of available health care services by effectively monitoring, evaluating and integrating direct clinical and supportive services in order to achieve and maintain optimal patient health status and expectations.  Ensures validity of accurate documentation of severity of illness (profiling) by working with the physician in the concurrent review process.   May assist with patient care services care coordination, psychosocial groups and/or complete biopsychosocial.

What you will do

• Provide assessment for all patients within Clinical Program to determine level of Case Management intervention

• Plan for high quality, realistic, and cost-effective/ resource driven continuum of care arrangements for identified patients

• Collaborate with physicians and appropriate members of the care team to plan, coordinate and revise the patient care plan as necessary

• Maintain communication with physicians and payers regarding situational comparison to criteria, plan of care and discharge plan

• Initiate/confirm admission authorization and certification for all days stayed

• Collaborate with other hospital departments, i.e. Finance, Hospital Information Management (Medical Records) and Admitting, to provide pertinent data relating to utilization management / clinical resource management issues and questions

Minimum Qualifications

• Master’s-level Licensed professional (LCSW, LMFT, LPC)
  or
  RN (Masters not required)

• State of Connecticut LCSW, LMFT, LPC or RN license in good standing required

• Minimum of one (1) year related mental health care experience

Position Highlights and Benefits

• Per diem

• Local residency required but may work from home

Ministry/Facility Information

Saint Mary’s Hospital is a Catholic, not-for-profit, acute care, community teaching hospital that has served Greater Waterbury since 1909.  Licensed for 347 beds, Saint Mary’s is designated as a Level II Trauma Center, offers award-winning cardiac and stroke care. We house the region’s only pediatric emergency care unit and was the first to introduce the daVinci® Robotic Surgery System.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.