Utilization Review Analyst
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Job Location:
Hamilton, MT - USA
Monthly Salary:
Not Disclosed
Posted on:
5 hours ago
Vacancies:
1 Vacancy
Job Summary
Review service plan requests from case managers daily
a. Ensure plans are detailed and comprehensive
i. Communicate with case managers in writing and by telephone to obtain information provide technical assistance and resolve service plan/ client issues.
ii. Review client files for information relevant to current service plan/request.
iii. Immediately alert the Manager/Administrator to any discrepancies or gaps.
b. Ensure plans are complete and include all required documentation
c. Provide initial guidance and ongoing technical assistance to new and current case managers.
d. Ensure plans comport with TBIF/DHS rules and regulations.
e. Ensure plans are fiscally viable (funds are available)
f. Confirm via the TBIF Vendor Database authorization of vendor and rates
g. Confirm via GLink Medicaid status for all beneficiaries upon request and annually (at a minimum)
h. Make service plan recommendations for Review Committee action. Include all relevant regulation citations for modify/deny recommendations.
i. 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.
j. 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.
k. After determination is made regarding service plans update TBIF beneficiary
