We save lives while providing the opportunity for people to realize their healthy selves.

　　Sr. Manager of Utilization Management

　　Monte Nido & Affiliates

　　Remote position (supporting the New England Region)

　　Monte Nido & Affiliates has been delivering treatment for eating disorders for over two decades.Our programs offer a model of treatment that blends medically sophisticated care with a personalized treatment approach. Our work is grounded in evidence-based strategies for adults and adolescents suffering from eating disorders. We work from a multi-disciplinary treatment team approach while integrating state-of-the-art medical, psychiatric, nutritional, and clinical strategies to provide comprehensive care within an intimate home setting.

　　The purpose of the Sr. Manager of Utilization Management position is to enhance and improve UM outcomes and ensure programmatic compliance with insurance company expectations across brands.

　　Summary of Benefits (https://montenidoaffiliates.icims.com/icims2/servlet/icims2?module=AppInert&action=download&id=5243&hashed=692313296)

　　Responsibilities Include:

　　Manage department staff, including all personnel decisions (hiring, on-boarding, training, supervising, monitoring, promoting, terminations, etc.) in collaboration with Human Resources

　　Manage day to day operations of department including but not limited to coverage of direct report’s caseloads, requesting post service authorization & and completing appeals.

　　Gather and report data on UR team’s review volume, compliance with payor requirements with discharge submissions, State/Medicaid/Payor Incident Reporting, quality of care reviews & investigations.

　　Manage and monitor status of direct reports uncovered clients, status of appeals, ensuring all appeals are followed through.

　　Ensure programs and UR team have access to and training on payor portals, payor review process, and any impactful state legislation.

　　Support implementation of MNA policies and procedures for completing UR and standardized clinical documentation system across

　　Develop and implement workflows as directed.

　　Make recommendations for clinical strategies to improve UR outcomes and meet KPI goals.

　　Collaborate with Clinical Program Directors to train & support staff on utilization review techniques & process. Provide them with support with problem solving including outreach to payors if indicated.

　　Provide case consultation on conceptualizing and presenting UR cases and maximizing client’s ability to access their benefits in both 1:1 meetings and by regularly attending program rounds.

　　Lead area Utilization Review Committee.

　　Work closely with Admissions, MNA UM teams, Compliance Department, Revenue Cycle Management, and others

　　Work with Dir of UM and Compliance to conduct quarterly medical records audits to ensure compliance with clinical documentation standards, payor requirements, and medical necessity criteria.

　　Participate in insurance-initiated audits.

　　Identify and communicate emerging trends with insurance companies.

　　Work with Director of Utilization management and MNA UM teams to maintain a database of medical necessity criteria and other necessary documents to support UR process & advocacy.

　　Coordinate with Dir of UM, UM team, Compliance, and additional departments to maintain database of payor clinical care guidelines, authorization and appeal process, and contacts.

　　Initiate and engage in collaborative calls with payors, attend quarterly payor meetings, and applicable association meetings.

　　Alert Director of UM to any concerning payor trends or payor barriers to clients accessing care and reach out to payors to address when needed.

　　Participate in Walden Behavioral Care leadership & Flash

　　Communicate and solve problems via chain of

　　Deliver care in a non-judgmental and non-discriminatory manner, sensitive to patient and staff

　　Seek corrective criticism and evaluate suggestions

　　Maintain acceptable overall

　　Promote a favorable/positive work atmosphere.

　　Attend in-services and educational training as necessary and as

　　Seek out learning experiences and incorporate new knowledge into

　　Maintain flexibility and adaptability to expected and unexpected changes in the work

　　Report incidents, accidents and occurrences in accordance with policies and

　　Maintain safety of the physical

　　Comply with facility policies and procedures.

　　Qualifications:

　　Graduation from an accredited college or university with a minimum of a Master’s Degree in Mental Health, Social Work, Nursing, Nutrition, or related field.

　　At minimum of two years of utilization review experience. Clinical experience in mental health or substance use treatment, preferably in higher levels of care, with in-depth knowledge of eating disorders and mental health or substance use programs.

　　Leadership or Training experience preferred.

　　Employee selection and performance management experience are a plus

　　Experience with health care policy or advocacy a plus

　　Active independent state license (or be independent license eligible)

　　Ability to work as a team member and have management, communication, organizational and interpersonal skills.

　　Ability to work under stressful conditions and be flexible in relation to department needs.

　　Knowledge of Managed Care Guidelines Knowledge of Medicare Guidelines.

　　Knowledge of Joint Commission Standards.

　　Knowledge of Parity

　　We are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

　　Our benefits include paid time off, 401(k) retirement plan, company-paid life and disability insurance, great medical and dental plan choices, vision, and many other insurance options to meet the needs of you and your loved ones.

　　#montenidoaffiliates

　　Graduation from an accredited college or university with a minimum of a Master’s Degree in Mental Health, Social Work, Nursing, Nutrition, or related field.

　　At minimum of two years of utilization review experience. Clinical experience in mental health or substance use treatment, preferably in higher levels of care, with in-depth knowledge of eating disorders and mental health or substance use programs.

　　Leadership or Training experience preferred.

　　Employee selection and performance management experience are a plus

　　Experience with health care policy or advocacy a plus

　　Active independent state license (or be independent license eligible)

　　Ability to work as a team member and have management, communication, organizational and interpersonal skills.

　　Ability to work under stressful conditions and be flexible in relation to department needs.

　　Knowledge of Managed Care Guidelines Knowledge of Medicare Guidelines.

　　Knowledge of Joint Commission Standards.

　　Knowledge of Parity

　　We are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

　　Our benefits include paid time off, 401(k) retirement plan, company-paid life and disability insurance, great medical and dental plan choices, vision, and many other insurance options to meet the needs of you and your loved ones.

　　#montenidoaffiliates

　　Manage department staff, including all personnel decisions (hiring, on-boarding, training, supervising, monitoring, promoting, terminations, etc.) in collaboration with Human Resources

　　Manage day to day operations of department including but not limited to coverage of direct report’s caseloads, requesting post service authorization & and completing appeals.

　　Gather and report data on UR team’s review volume, compliance with payor requirements with discharge submissions, State/Medicaid/Payor Incident Reporting, quality of care reviews & investigations.

　　Manage and monitor status of direct reports uncovered clients, status of appeals, ensuring all appeals are followed through.

　　Ensure programs and UR team have access to and training on payor portals, payor review process, and any impactful state legislation.

　　Support implementation of MNA policies and procedures for completing UR and standardized clinical documentation system across

　　Develop and implement workflows as directed.

　　Make recommendations for clinical strategies to improve UR outcomes and meet KPI goals.

　　Collaborate with Clinical Program Directors to train & support staff on utilization review techniques & process. Provide them with support with problem solving including outreach to payors if indicated.

　　Provide case consultation on conceptualizing and presenting UR cases and maximizing client’s ability to access their benefits in both 1:1 meetings and by regularly attending program rounds.

　　Lead area Utilization Review Committee.

　　Work closely with Admissions, MNA UM teams, Compliance Department, Revenue Cycle Management, and others

　　Work with Dir of UM and Compliance to conduct quarterly medical records audits to ensure compliance with clinical documentation standards, payor requirements, and medical necessity criteria.

　　Participate in insurance-initiated audits.

　　Identify and communicate emerging trends with insurance companies.

　　Work with Director of Utilization management and MNA UM teams to maintain a database of medical necessity criteria and other necessary documents to support UR process & advocacy.

　　Coordinate with Dir of UM, UM team, Compliance, and additional departments to maintain database of payor clinical care guidelines, authorization and appeal process, and contacts.

　　Initiate and engage in collaborative calls with payors, attend quarterly payor meetings, and applicable association meetings.

　　Alert Director of UM to any concerning payor trends or payor barriers to clients accessing care and reach out to payors to address when needed.

　　Participate in Walden Behavioral Care leadership & Flash

　　Communicate and solve problems via chain of

　　Deliver care in a non-judgmental and non-discriminatory manner, sensitive to patient and staff

　　Seek corrective criticism and evaluate suggestions

　　Maintain acceptable overall

　　Promote a favorable/positive work atmosphere.

　　Attend in-services and educational training as necessary and as

　　Seek out learning experiences and incorporate new knowledge into

　　Maintain flexibility and adaptability to expected and unexpected changes in the work

　　Report incidents, accidents and occurrences in accordance with policies and

　　Maintain safety of the physical

　　Comply with facility policies and procedures.