Utilization Rate Specialist

Job Description

Beacon is a successful and national behavioral health company providing residential-based services and supports to children and adults with Intellectual and Developmental Disabilities, Severe Mental Illness, Autism, and high-acuity behaviors. All activities related to this position must be delivered in compliance with the company’s policies and procedures, accreditation standards, state and federal licensing requirements, HCBS guidelines, and the contractual requirements of Community Mental Health Agencies and other regulatory bodies. You are expected to be aligned with the goals and mission of the organization, and to perform in accordance with our “I CARE” core values of the organization – Integrity, Compassion, Advocacy, Respect and Excellence.

Position Summary:

The Utilization Rate Specialist is responsible for monitoring, analyzing and reporting on staff and program utilization rates. They will work closely with leadership to ensure records are updated and maintained with comprehensive information and ensure staffing patterns are adequate for the services being provided.

Primary Responsibilities:

• Always be compliant with all company and regulatory policies and procedures.
• Review and process service authorization requests in accordance with regulations and state Medicaid guidelines.
• Ensure that service authorizations align with individualized treatment plans and client needs.
• Communicate with internal teams, external providers, and stakeholders to ensure timely and accurate processing of service authorizations.
• Track and document service authorizations, updates, and renewals to ensure compliance with state and federal requirements.
• Conduct intake assessments for new clients to determine eligibility and appropriate level of service.
• Coordinate with clinical staff to ensure that all necessary information is obtained for authorization and service planning.
• Manage the renewal process for ongoing services, ensuring that reauthorization is completed in a timely manner to avoid service disruptions.
• Update and maintain client records with accurate, comprehensive information about services provided and client progress.
• Monitor and assess staffing patterns to ensure adequate coverage for client services while meeting the standards set by regulations.
• Collaborate with program managers and clinical staff to ensure that staffing aligns with service utilization and compliance requirements.
• Recommend adjustments to staffing plans based on service demand, client needs, and efficiency goals.
• Review and process exception rate requests for clients who require services outside the standard rate or service parameters.
• Collaborate with clinical teams to assess the necessity and justification for exception rate requests.
• Submit exception rate documentation to appropriate funding and regulatory bodies, ensuring that all necessary information and justifications are included.
• Continuously evaluate service utilization processes to identify opportunities for improvement in efficiency, quality, and compliance.
• Actively participate in team meetings and collaborate on initiatives to optimize the client experience while ensuring regulatory compliance.
• Attends conferences, trainings, seminars and other professional skill development and enhancement activities as approved by leadership.

Education and Qualifications:

• Bachelor’s degree in a behavioral health related discipline is preferred.
• A minimum of 3-5 years’ previous experience in a human service-related field, preferably behavioral healthcare.
• At least 2 years of experience in mental health service authorization or utilization management within a community residential setting.
• Must pass criminal background check.
• Must possess a valid Driver’s License.
• Proficient in speaking, reading and writing the English language.
• Approved by state, federal and government entities to work within BSLS programs.
• Ability to use office equipment, including BSLS information technology systems.

Skills and Abilities:

• Must be able to communicate and function in an interdisciplinary team.
• Strong computer skills utilizing various software programs and applications.
• Excellent oral and written communication skills.
• Ability to create professional employee communication materials.
• Capable of working well with all levels of the organization.
• A professional demeanor.
• Demonstrated ability to multi-task.
• Ability to work with little daily supervision.

Work Environment:

This is a hybrid position. When not remote, time will be spent in Mendota Heights, MN office.

This is a full-time position. Days and hours of work are Monday through Friday, 8:00 a.m. to 5:00 p.m. Occasional evening and weekend work may be required as job duties demand.

AAP/EEO Statement: It is the policy of Beacon to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Beacon will provide reasonable accommodation for qualified individuals with disabilities.