Utilization Review Coordinator

About this role

Mentor Community Services, a part of the Sevita family, provides community-based services for individuals with intellectual and developmental disabilities. Here we believe every person has the right to live well, and everyone deserves to have a fulfilling career. You’ll join a mission-driven team and create relationships that motivate us all every day. Join us today, and experience a career well lived.
Program Administration Utilization Review Coordinator $23.08-24.04 hourly Monday-Friday - Remote Based in Eastern timezone 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

Qualifications:

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

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

Why Join Us?

Full compensation/benefits package for full-time employees.

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

We have meaningful work for you – come join our team – apply today!
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 all over the U.S.
As an equal opportunity employer, we do not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, citizenship, or any other characteristic protected by law.
Originally posted on Himalayas