Overview

A Utilization Management Specialist - Bed Based Care is needed to help us in our endeavor to build the healthiest community in the nation … one person at a time.

This position will be based at the new and innovative acute care behavioral health facility, which opened in late 2023. SummitStone has the privilege of partnering closely with Larimer County on this venture. This voter-approved facility provides licensed, equitable and culturally relevant care and treatment to individuals in crisis with mental health and/or substance use disorders. For more information click HERE.  

The Mission: 

At SummitStone Health Partners, we strive to foster trust, empower recovery, and inspire hope to strengthen and enrich our Northern Colorado community.

We need your help to make this vision a reality.  

We are building a team who believes in providing crucial services at crucial times, helping the people in our community at their most vulnerable — particularly those who are often overlooked and underserved.

We Embrace Our Diversity

Come As You Are:

A core value here at SummitStone.  

We want you to be your authentic self while at work, so we welcome and actively seek team members of different backgrounds, identities and experiences. SummitStone is committed to fostering a diverse and inclusive environment, honoring each individual's whole-self by embracing differences in race, ethnicity, ability, age, gender, sexual orientation, spiritual beliefs, socioeconomic status, language and the inherent intersections of many different identities. We invite everyone to share our journey and are proudly an equal opportunity employer. 

Experiences and Backgrounds We Look For

If this sounds like your calling, then we want to help you succeed, grow, and thrive at SummitStone. 

• Location: Fort Collins, CO at our Longview Campus
• Status: Full-time, 40/hrs. week 

What You’ll Do:

Responsible for leading the utilization review, authorization and transitional case management for clients in our bed-based care facilities including Behavioral Health Urgent Care, 23-hour observation, Crisis Stabilization Unit, ASAM 3.7 Residential, ASAM 3.2 Withdrawal Management and ASAM 3.7 Withdrawal Management units with SummitStone Health Partners. Collaborate with the treatment team to ensure admission and continued stay criteria have been met and service authorization is obtained. This position will work closely with the Revenue Cycle Management (RCM) department to streamline insurance authorization and address documentation, and billing issues related to the delivery of our acute care and residential behavioral health services.

Duties include, but are not limited to: 

• Manage all Utilization Management (UM) processes including completing pre-authorization forms, reviewing forms of clinical information for medical necessity, referring to treatment team if necessary, coordinating authorization calls between payers and treatment team, and conducting concurrent reviews, extensions of care, discharge planning, and retrospective reviews.
• Maintain accurate recordkeeping and prompt communication with all individuals involved with the approval of service and payment, including the treatment team and RCM department.
• Collaborate with RCM to understand billing and coding practices and processes for reimbursement and payment of services rendered as well as authorizations or claims adjudication discussions needed.
• Monitor referral patterns and make recommendations on strategies to contain costs, improve access    and ensure quality care.
• Relay information to the multidisciplinary treatment team regarding authorization review results and assist with coordination of care as required.  Partner in coordinating transitions of care as it relates to discharge of clients from bed-based care at SHP.
• Collaborate as a member of an interdisciplinary team. Contribute actively and effectively with the medical provider, clinical staff, case manager and other members of the healthcare team to ensure appropriate plans of care, along with appropriateness of services being rendered.  Function in an integrated role with other internal employees and external community partners to ensure teamwork, best practices, and continuity of care for clients across the agency.
• Establish effective rapport with other employees, professional support staff, clients and families, and others involved in providing coordinated care for clients.
• May participate on committees (both internal and external), in meetings, and work on special projects as needed.
• May assist with accreditation compliance and outreach activities.
• Perform other duties as assigned.

Required:

• Master's degree in counseling, psychology, social work, or related field from accredited college or university or BSN/RN
• At least one year of experience in inpatient utilization management in behavioral health, care coordination and/or case management for high-risk populations, 3 years preferred
• Equivalent combination of education and experience may be evaluated and considered

Preferred:

• CAS or LAC preferred 
• Colorado Clinical Mental Health License (LCSW, LPC, LMFT) preferred
• Bilingual/bi-cultural preferred 

Start With Yes

At SummitStone, we show up not only for our clients, but for our staff as well. You will be joining a team of committed professionals who believe in the power of starting with “yes” — where an unparalleled level of teamwork and support can solve any challenge. 

We believe that people can and do recover, but we also know that they can’t always do it on their own. That’s where you come in. If you have any or all of these qualities, we want you to consider us for your next career move: 

• You believe in being a voice for behavioral health in Northern Colorado
• You embrace equity for your clients, teammates, and partners
• Collaboration and creativity are crucial to helping you solve problems
• You show up as your genuine self to help guide others through their toughest times
• Through continuous curiosity, exploration, and reflection, you’re eager to adapt and learn

Total Rewards

The typical hiring range for this position is $66,040 - $79,217 annually, based on relevant years of experience.  

Benefits

We know that most people aren’t just searching for a job, they’re searching for a career. 

But more than that, they’re searching for a sense of belonging and purpose. Whether you’re at the start of your journey or you already know where you want to be, you will have access to a level of support and teamwork that is uncommon in the field of behavioral health today. 

Along with that, positions are eligible* for range of benefits including: 

Time that you deserve for a balanced life 

• Flextime Scheduling 
• Paid Time Off (PTO) 
• Ten paid holidays, including one floating holiday 
• Extended Leave Bank (ELB) 

Financial benefits 

• 403(b) Retirement Plan with an employer match 
• Referral Bonus available for employee who refer new hires 
• Ongoing support for learning and development, including reimbursement and supervision for license and certification 

Health, Medical, and Wellness 

• Medical Insurance 
• Dental & Vision Insurance 
• Life Insurance and Long-Term Disability (LTD) 
• Malpractice Insurance 
• Option to participate in Employee Resource Groups 

*Based on working 20+ hours per week

Reach Out

SummitStone will provide persons with disabilities reasonable accommodations. If reasonable accommodation is needed to participate in the job application or selection process, please let your recruiter know. 

Questions?  Please email us at hiring@summitstonehealth.org.