Utilization Reviewer / Management Analyst 2

State of Minnesota    Anoka, MN
Job Description

The Utilization Reviewer assesses patient medical records upon admission and during continued stay for documentation that supports the need for treatment and services at the level of care provided, based on program specific criteria and in accordance with federal and state regulations. The Utilization Reviewer conducts electronic medical record reviews to support all Direct Care and Treatment mental health, chemical health and forensic programs across Minnesota and review all patients, regardless of payment source. These programs include services for adult mental health inpatient services, substance abuse and dependency, child and adolescent behavioral health, forensic services, and community residential and day treatment. Utilization Reviewers obtain insurer and payer authorizations for treatment, where applicable, and facilitate notification of the treatment team and person receiving services, when further treatment does not meet continued stay criteria.

Primary Responsibilities Include:

  • Assessing level of care needs for clients upon admission and during their continued care stays to assess and monitor care levels for appropriateness and medical necessity
  • Participating in data collection, analysis and presentation of utilization management information
  • Coordinating utilization review activities with program billing processes
  • Participating in development and implementation of utilization management training efforts, which includes training on data entry and recommending improvements to utilization review and data management policies and processes
  • Qualifications Minimum Qualifications:

    1 year professional OR 3 years advanced technical or paraprofessional experience that demonstrates the following:

  • General insurance billing practices and experience
  • Data collection and analysis; including the use of computer systems and applications used for data collection and reporting
  • Evaluating the effectiveness of data processing tools to recommend new methods and procedures
  • OR

  • Master’s degree in Psychology, Business Management, Healthcare Administration, Nursing or closely related field
  • Note: A Bachelor’s degree in Psychology, Business Management, Healthcare Administration, Nursing or closely related field may substitute for 1 year of experience at the technical and paraprofessional level

    Preferred Qualifications:
  • Bachelor’s degree or higher in Psychology, Business Management, Healthcare Administration, Nursing or closely related field
  • Care delivery in a behavioral health facility
  • Additional Requirements

    To facilitate proper crediting, please ensure that you clearly describe your experience in the areas listed above. REFERENCE/BACKGROUND CHECKS - The Department of Human Services will conduct reference checks to verify job-related credentials and criminal background check prior to appointment.

    EDUCATION VERIFICATION - Applicants will be required to provide a copy of their high school diploma at time of interview OR copies of their college transcript or college degree/diploma at time of interview. Copies of the college degree/diploma are acceptable ONLY if it clearly identifies the field in which it was earned.

    Application Details Why Work For Us

    GREAT BENEFITS PACKAGE! The State of Minnesota offers a comprehensive benefits package including low cost medical and dental insurance, employer paid life insurance, short and long term disability, pre-tax flexible spending accounts, retirement plan, tax-deferred compensation, generous vacation and sick leave, and 11 paid holidays each year.

    Our mission as an employer is to actively recruit, welcome and support a workforce, which is diverse and inclusive of people who are underrepresented in the development of state policies, programs and practices, so that we can support the success and growth of all people who call Minnesota home.

    How to Apply

    Click Apply at the bottom of the page. If you have questions about applying for jobs, contact the job information line at 651-259-3637.

    For additional information about the application process, go to http://www.mn.gov/careers.


    If you have questions about the position, contact Janel Jensen at janel.c.jensen@state.mn.us.

    If you are a Connect 700 applicant, please email your certificate and the job ID to Heidi Peura at heidi.peura@state.mn.us by the position close date.

    If you are an individual with a disability and need an ADA accommodation for an interview, you may contact the Department of Human Services’ ADA Coordinator at 651-431-4945 for assistance.


    The State of Minnesota is an equal opportunity, affirmative action, and veteran-friendly employer. We are committed to providing culturally responsive services to all Minnesotans. The State of Minnesota recognizes that a diverse workforce is essential and strongly encourages qualified women, minorities, individuals with disabilities, and veterans to apply.

    We will make reasonable accommodations to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-259-3637 or email careers@state.mn.us. Please indicate what assistance you need.

    Fri, 15 Mar 2019 08:05:51 GMT

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