Utilization Review Analyst Hybrid

We are hiring Utilization Review Analyst Hybrid for one of our clients in Hamilton NJ.

Job Description:

Review service plan requests from case managers daily

• Ensure plans are detailed and comprehensive
  • Communicate with case managers in writing and by telephone to obtain information provide technical assistance and resolve service plan/ client issues.
  • Review client files for information relevant to current service plan/request.
  • Immediately alert the Manager/Administrator to any discrepancies or gaps.
• Ensure plans are complete and include all required documentation
• Provide initial guidance and ongoing technical assistance to new and current case managers.
• Ensure plans comport with TBIF/DHS rules and regulations.
• Ensure plans are fiscally viable (funds are available)
• Confirm via the TBIF Vendor Database authorization of vendor and rates
• Confirm via GLink Medicaid status for all beneficiaries upon request and annually (at a minimum)
• Make service plan recommendations for Review Committee action. Include all relevant regulation citations for modify/deny recommendations.
• After determinations are made - send all APPROVED service plans to the admin. staff within two (2) business days following receipt of information from Manager/Administrator for letter preparation including amount of funds spent to date.
• After determinations are made - send to the admin. staff service plans with in two (2) business days following receipt of information from Manager/Administrator language addressing modifications hold denials or other Review Committee decisions for letter preparation including amount of funds spent to date.
• After determination is made regarding service plans update TBIF beneficiary
• Continuously update service plan tracker
• Upload the original and final service plan packet (all documentation provided to the Review Committee) into IQ along with any pertinent emails and notes.
• Ensure that the final service plan packet is in hardcopy file.
• Update Client Roster after each Review Committee meeting.

Assist with Coordination of Review Committee Meetings

• Abstract service plans to be presented for consideration by the TBI Fund Review Committee and save in Abstract folders.
  • Format plans
  • Create and complete cover sheets
  • Provide recommendation and justification
  • Upload supplemental documentation as pdfs
• As necessary review pre-meeting feedback from the Review Committee and provide information.
• Participate in monthly TBIF Review Committee meeting as requested.

Process TBI Fund Payment Vouchers

• Ensure invoice is complete includes all required information and formatted appropriately;
  • Double check that math adds up
  • Verify type of service rates and award dates match GOP
  • Check availability of funds
• Communicate with service providers as needed to obtain missing or incomplete invoice information
• Create vouchers using appropriate forms; review and save completed vouchers to Completed Vouchers online folder.
• Print vouchers and invoices for Director