Axiom Care
About Axiom Care
At Axiom Care, we pride ourselves on offering a real path to recovery from addiction to underserved populations such as those with low incomes and the prison re‑entry population. We achieve this by offering multiple levels of care along with medical services, evidence‑based professional counseling, case management, housing, employment assistance, and more throughout the Phoenix metro area.
Job Summary
The UR Manager primary responsibility is managing, reviewing, and monitoring utilization of patient resources and obtaining payor authorization as required for all provided services. The UR Manager will function as liaison between payor source(s), the finance office, and the clinical treatment team, providing information and feedback to assist in optimum patient care and reimbursement.
Duties/Responsibilities
Review of patient admission data and clinical documentation to ensure compliance with insurance and governmental regulations relating to medical necessity and case documentation.
Preparing prior authorization and concurrent review authorization requests and maintaining detailed and complete documentation regarding the UR process for each case.
Consultation with medical and treatment staff regarding patient diagnosis, medical justification, length of treatment, and case documentation.
Participation with departmental staff in utilization and quality improvement meetings and projects.
Preparing memorandum, letters, correspondence, and comprehensive UR status summaries.
Other duties as assigned.
Monitor UR team to ensure all reviews are completed in a timely matter.
Report any changes in payer process for authorization.
Coordinate Treatment Teams for all facilities to assure accuracy on patients’ cases.
Provide Trends of Denials, Peer to Peers, regulations of payers that will affect reimbursement.
Establish work relationships with provider reps from all insurance companies.
Establish training system for UR new hires, PRN, coverage.
Work alongside Ed’s and CD’s to ensure treatment team is being completed for proper utilization services.
Provide payer trends, denials, UR team schedule, coverage schedule, any issue to Director of Revenue Cycle.
Why Join Axiom Care? Benefits:
We take care of our team so you can take care of others. Enjoy medical and dental coverage through Banner|Aetna, vision insurance through EyeMed, a 401(k) with employer match through Principal, tuition reimbursement, generous PTO and sick time, and eight paid holidays — plus added perks like life insurance and wellness benefits.
Requirements Qualification Requirements
Bachelor’s degree or at least five years of UR, case management with medical detox, or behavioral health experience
Utilization Review: 1-2 years preferred.
Knowledge of:
Psychological and social aspects and characteristics of mental illness and chemical dependency.
Principles and methods of counseling and the accepted techniques for assessing psycho‑social behavior.
Human behavior and development.
Problems needs and attitudes chemically dependent and dually diagnosed.
Pertinent laws and regulations regarding health and social service programs.
Federal, state and county regulations pertaining to utilization review.
Methods and procedures of admissions, discharges and patient care in outpatient and inpatient behavioral health facilities.
Medically Necessary Criteria of major third‑party funding sources.
Ability to: Communicate effectively in oral and written format.
Navigate and effectively utilize relevant software such as Office 365, Smartsheet’s, Kipu, and Collaborate MD.
Maintain effective interpersonal relationships with the clinical, medical, and administrative teams.
Understand and apply state, federal, and local regulations and laws governing quality assurance and utilization review.
Work independently.
Analyze treatment plans and evaluate elements of assessment which include the diagnosis of client behavioral and emotional problems.
Confidently alert medical staff and clinicians of any lack of needed UR documentation for priority completion.
Use good judgment in order to make critical decisions about the medical necessity of treatment.
Provide ongoing updates and notifications in the Sigmund Electronic Management system.
Supervisory Responsibilities
Accomplishes billing human resource objectives by selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining employees; communicating job expectations; planning, monitoring, appraising job contributions; adhering to policies and procedures.
Performance Standards
Employees are required to maintain an above average status in the following performance standards:
Attitude at work, toward supervisor, co‑workers, and internal/external customer
Reliability, Initiative and Job Commitment
Product or Job Skills Knowledge
Keeping promises to customers/follow‑through
Quality and Quantity of Work
Competencies Technical Knowledge – Knowledge of or ability to learn QuickBooks Online, SharePoint, OneDrive, Kipu, Collaborate MD, various payor portals.
Financial Competency and discretion – Understanding of revenue cycle and accounting procedures. Ability to discern and keep financial matters confidential.
Quality Management – Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
Manage Performance - Set clear expectations, write, and monitor employee goals, hold employees accountable for job responsibilities and achieving goals, reward employees, mentor coach and discipline employees when necessary. Create system to manage performance and do so consistently and fairly.
Strategic Thinking – Develops strategies to achieve organizational goals; Understands organization’s strengths and weaknesses; Analyzes market and competition; identifies external threats and opportunities; Adapts strategy to changing conditions.
Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to stand and walk; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to stand. The employee is occasionally required to sit; climb or balance; stoop, kneel, crouch, or crawl and talk or hear.
The employee may occasionally lift and/or move up to 25 pounds.
Disclaimer The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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Job Summary
The UR Manager primary responsibility is managing, reviewing, and monitoring utilization of patient resources and obtaining payor authorization as required for all provided services. The UR Manager will function as liaison between payor source(s), the finance office, and the clinical treatment team, providing information and feedback to assist in optimum patient care and reimbursement.
Duties/Responsibilities
Review of patient admission data and clinical documentation to ensure compliance with insurance and governmental regulations relating to medical necessity and case documentation.
Preparing prior authorization and concurrent review authorization requests and maintaining detailed and complete documentation regarding the UR process for each case.
Consultation with medical and treatment staff regarding patient diagnosis, medical justification, length of treatment, and case documentation.
Participation with departmental staff in utilization and quality improvement meetings and projects.
Preparing memorandum, letters, correspondence, and comprehensive UR status summaries.
Other duties as assigned.
Monitor UR team to ensure all reviews are completed in a timely matter.
Report any changes in payer process for authorization.
Coordinate Treatment Teams for all facilities to assure accuracy on patients’ cases.
Provide Trends of Denials, Peer to Peers, regulations of payers that will affect reimbursement.
Establish work relationships with provider reps from all insurance companies.
Establish training system for UR new hires, PRN, coverage.
Work alongside Ed’s and CD’s to ensure treatment team is being completed for proper utilization services.
Provide payer trends, denials, UR team schedule, coverage schedule, any issue to Director of Revenue Cycle.
Why Join Axiom Care? Benefits:
We take care of our team so you can take care of others. Enjoy medical and dental coverage through Banner|Aetna, vision insurance through EyeMed, a 401(k) with employer match through Principal, tuition reimbursement, generous PTO and sick time, and eight paid holidays — plus added perks like life insurance and wellness benefits.
Requirements Qualification Requirements
Bachelor’s degree or at least five years of UR, case management with medical detox, or behavioral health experience
Utilization Review: 1-2 years preferred.
Knowledge of:
Psychological and social aspects and characteristics of mental illness and chemical dependency.
Principles and methods of counseling and the accepted techniques for assessing psycho‑social behavior.
Human behavior and development.
Problems needs and attitudes chemically dependent and dually diagnosed.
Pertinent laws and regulations regarding health and social service programs.
Federal, state and county regulations pertaining to utilization review.
Methods and procedures of admissions, discharges and patient care in outpatient and inpatient behavioral health facilities.
Medically Necessary Criteria of major third‑party funding sources.
Ability to: Communicate effectively in oral and written format.
Navigate and effectively utilize relevant software such as Office 365, Smartsheet’s, Kipu, and Collaborate MD.
Maintain effective interpersonal relationships with the clinical, medical, and administrative teams.
Understand and apply state, federal, and local regulations and laws governing quality assurance and utilization review.
Work independently.
Analyze treatment plans and evaluate elements of assessment which include the diagnosis of client behavioral and emotional problems.
Confidently alert medical staff and clinicians of any lack of needed UR documentation for priority completion.
Use good judgment in order to make critical decisions about the medical necessity of treatment.
Provide ongoing updates and notifications in the Sigmund Electronic Management system.
Supervisory Responsibilities
Accomplishes billing human resource objectives by selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining employees; communicating job expectations; planning, monitoring, appraising job contributions; adhering to policies and procedures.
Performance Standards
Employees are required to maintain an above average status in the following performance standards:
Attitude at work, toward supervisor, co‑workers, and internal/external customer
Reliability, Initiative and Job Commitment
Product or Job Skills Knowledge
Keeping promises to customers/follow‑through
Quality and Quantity of Work
Competencies Technical Knowledge – Knowledge of or ability to learn QuickBooks Online, SharePoint, OneDrive, Kipu, Collaborate MD, various payor portals.
Financial Competency and discretion – Understanding of revenue cycle and accounting procedures. Ability to discern and keep financial matters confidential.
Quality Management – Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
Manage Performance - Set clear expectations, write, and monitor employee goals, hold employees accountable for job responsibilities and achieving goals, reward employees, mentor coach and discipline employees when necessary. Create system to manage performance and do so consistently and fairly.
Strategic Thinking – Develops strategies to achieve organizational goals; Understands organization’s strengths and weaknesses; Analyzes market and competition; identifies external threats and opportunities; Adapts strategy to changing conditions.
Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to stand and walk; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to stand. The employee is occasionally required to sit; climb or balance; stoop, kneel, crouch, or crawl and talk or hear.
The employee may occasionally lift and/or move up to 25 pounds.
Disclaimer The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
#J-18808-Ljbffr