Utilization Rate Specialist

Company Summary :

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.
• Performs other duties as assigned or requested.

Education and Qualifications :

Skills and Abilities :

Work Environment :

This is a hybrid position. Office time is located in Mendota Heights, Minnesota.

Travel : No travel required.

Physical Demands :

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.

While performing the duties of this job, the employee is regularly required to talk or hear. Specific vision abilities required by this job include close vision and the ability to adjust focus. This would require the ability to lift files, open filing cabinets, and bend or stand on a stool as necessary.

Position Type / Expected Hours of Work :

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.