Card Fraud Analyst focusing on acquiring - side card fraud in a Lagos - based fintech startup. Engage in fraud analysis, prevention, and collaboration for an impactful product.
About the role
- Utilization Review Analyst analyzing acute care authorizations while ensuring effective resource use. Collaborating with providers and maintaining compliance with regulations in a hybrid work environment.
Responsibilities
- Promotes appropriate, effective, and efficient use of resources via concurrent reviews of acute care authorizations
- Analyzes records to determine legitimacy of admission, treatment, and length of stay in acute care
- Compares inpatient medical records to established criteria and confers with OCHN provider personnel as well as personnel in acute care and other professional staff
- Determines continued stay review dates according to established clinical protocols and diagnostic criteria
- Conducts continued stay reviews and determines continued authorization status
- Coordinates with OCHN and acute care providers to ensure appropriate communication and discharge planning occurs
- Accountable for timely and comprehensive review of clinical data with concise documentation, decisions and rationale
- Leverages clinical knowledge, business rules, regulatory guidelines and policies and procedures to determine clinical appropriateness for acute care authorizations
- Participate in workgroups and committees with other OCHN Teams
Requirements
- Master's degree in mental health field
- State of Michigan license, certification and/or registration as, Psychologist (LLP, LP), Social Worker (LMSW), Counselor (LPC), Marriage and Family Therapist (LMFT) or Nurse (RN)
- Minimum of five (5) years relevant experience providing services to Adults with Mental Illness, Intellectual or Developmental Disabilities, Substance Use Disorder and/or children with serious emotional disturbance or intellectual or Development Disabilities
- Knowledge of the Michigan Mental Health Code
- Understanding of Medicaid rules and regulations
- Understanding of utilization management
- Preference for knowledge of the OCHN Utilization Management Manual and Protocols
- Demonstrated effective interpersonal skills
- Demonstrated ability to work effectively in a team environment
- Demonstrated effective written and oral communication skills
- Demonstrated effective computer skills
Benefits
- Hybrid (onsite/remote) work schedule available
- Must have available means of transportation to and from OCHN and for required offsite meetings or site visits
- Must be available for meetings and events which may occur outside of standard office hours
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