Utilization Case Manager

Helio Health is on a mission to treat and promote recovery from the effects of substance use, mental health disorders, and other behavioral healthcare issues. To support the mission of Helio Health, the Utilization Case Manager will enhance the program’s efforts to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Time basis supporting our Inpatient, Detox and Residential programs.

• Review precertification requests for medical necessity, referring to the medical provider those that require additional expertise. 
• Review clinical information for concurrent reviews, extending the length of stay for patients/residents as appropriate.
• Assist in developing and administering policies and procedures for utilization.
• Negotiating access to care for individuals seeking services at Helio Health, Inc.
• Educate program staff on current principles and standards of practice surrounding utilization and denials management.
• Use effective relationship management, coordination of services, resource management, education, and patient advocacy to promote improved quality of care and/or life.
• Performs quality assurance activities to include:
• Provides services according to agency policies, procedures, program guidelines and governmental regulations.
• Monitors provision of services when assigned.
• Evaluates program and identifies strengths and weaknesses.
• Assists In problem resolution and implementation of supervisor approved program modifications.

• Associate's degree required, Bachelor's degree preferred.
• Licensed/credentialed applicants preferred.
• Two years of experience in utilization review in a hospital, health care, or managed care setting. 
• Knowledge of federal and state regulations applicable to treatment and reimbursement.
• Utilization review procedures and techniques.

Our Comprehensive Employee Benefits Package Includes: 

• Health insurance including dental and vision for employees and families. 
• Paid Vacation and Sick leave - No Waiting Period for accruals. 
• Paid holidays, including a floating birthday holiday. 
• 401(k) plan with up to 5% company match. 
• Company paid short-term disability insurance. 
• Company sponsored life insurance. 
• Employee Assistance Program (EAP). 

Helio Health provides equal opportunity to all employees and applicants for employment, without regard to race, creed, color, sex (including pregnancy, gender identity and sexual orientation), parental status, religion, national origin, citizenship, status as a victim of domestic violence, age, military or veteran status, handicap or disability, family medical history or predisposing genetic characteristics or carrier status, marital status, family status, political affiliation, felony conviction record, status as a victim of a crime, or status as an employee who has complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit, or any other categories, status or activity protected by federal, state or local law.   

Salary and hourly compensation ranges are provided in accordance with NYS law and are based on Helio Health's good faith belief of what is accurate at the time of posting. Salary and hourly compensation offers are based on candidate's education level and experience relevant to the position and also take into account information provided by the hiring manager and program