Utilization Rate Specialist

Position Summary:

The Utilization Rate Specialist is responsible for monitoring, analyzing, and optimizing workforce utilization to ensure effective allocation of resources and alignment with organizational productivity goals. This role supports operational efficiency by tracking utilization metrics, identifying trends and gaps, and providing actionable insights to management.

The specialist collaborates with business leaders, finance teams, and workforce planners to ensure appropriate staffing levels, improve capacity planning, and maximize billable or productive time. They play a key role in maintaining data accuracy, generating regular reports, and recommending process improvements to enhance overall performance.

This position can be done remotely. 

Primary Responsibilities:
• 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.
• Adheres to BSLS Core Values, Mission Statement, and Corporate Philosophies.


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 checks, central registry check (in applicable states) and child abuse registry (in applicable states).
• Must complete and pass a drug test, in applicable states.
• Must possess a valid Driver’s License and have reliable transportation.
• Proficient in speaking, reading and writing the English language.

Experience with billing, budgets, spreadsheets and working with authorizations is required.