UM/Data Specialist

About This Role

The UM/Data Specialist will work with the Utilization Management department to ensure timely handling of Medicaid and other authorizations. This role involves completing and submitting authorization summaries, tracking authorization statuses, and communicating with various departments.

Responsibilities

• Complete authorization service summaries for C&A, EA and IC3 CMO consumers in a timely manner as additional units are needed or when authorization dates end
• Send CMO OTR summary authorization requests for C&A and EA to B12 UM department for submittal
• Submit GAMMIS for IC3 CMO consumers
• Complete and submit summaries before authorization expires or units are out
• Complete ASOs for APS Medicaid/FFS/State Contracted consumers no later than 5 days after additional service is needed
• Submit ASO's and provided documents for CMO’s, Medicaid/FFS/State Contracted consumers via GAMMIS for Autism services
• Submit ASO’s for Medicaid/FFS/SCS consumers via CareLogic for IC3 services
• Communicate with UM department B12 immediately via email when receiving an authorization or a denial
• Check UM reports from Tanika and other UM members to ensure that no insurances have been discontinued or changed
• Track dates that authorizations are submitted to UM department and notify UM/Program Director/case manager if authorization requests are not answered

Requirements

• High School Diploma/GED (or equivalent)
• Previous experience working with qualitative data and research
• Proficiency in Microsoft Office products
• Attention to detail and problem-solving skills
• High level of professionalism
• Strong written and verbal communication skills
• Excellent time management & organizational skills

Qualifications

• High School Diploma/GED

Nice to Have

• Bachelor’s degree in a related field

Skills

* Required skills

Benefits