Top 31 Medicaid liaison Jobs in Columbus

Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
- Weekends as needed
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid time off
- 401(k) matching
Quick Apply
6d
Patient Care Representative
HEART OF OHIO FAMILY HEALTH CENTERS —Columbus, OH
- $20 an hour
- Weekends as needed
- Writing skills
- HIPAA
- Research
Quick Apply
Community Health Worker
CENTRAL OHIO AREA AGENCY ON AGING —Columbus, OH
- $25 an hour
- Full-time
- Writing skills
- Office
- High school diploma or GED
- Mileage reimbursement
Quick Apply
Financial Counselor
Mount Carmel —Grove City, OH
- Full-time
- Surgery
- Hospital
- Mid-level
- Relocation assistance
- Health insurance
12d
Health Planning Administrator 3 - 20014670
State of Ohio - Health —Columbus, OH
- $44.38 an hour
- Full-time
- Background check
- Office
- Criminal background check
- Paid holidays
- Health insurance
3d
Quality Outreach Coordinator - PFK Clinical Integration
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Ability to climb stairs
- Driver's License
- Bachelor's degree
3d
Physician Liaison
Bierman Autism Centers —Dublin, OH
- $80,000 - $90,000 a year
- Full-time
- Applied behavior analysis
- Marketing
- Hospital
- Disability insurance
- Dental insurance
Quick Apply
Director of Job & Family Services
Delaware County, OH —Delaware, OH
- $108,396 - $157,174 a year
- Full-time
- Clean driving record
- Research
- Office
- Dental insurance
- Flexible spending account
1d
Case Manager - Foster Care (OH)
Necco —Columbus, OH
- On call
- School experience
- LPC
- Mid-level
- Opportunities for advancement
Quick Apply
13d
Business Office Manager - Senior Living
Wallick Properties Midwest LLC —Columbus, OH
- From $52,000 a year
- Full-time
- Background check
- Microsoft Excel
- Pass drug screening
- Paid parental leave
- Health insurance
Quick Apply
Medical Science Liaison, Respiratory - Ohio (OH, KY, IN, MI)
GlaxoSmithKline —Columbus, OH
- $168,750 - $281,250 a year
- Full-time
- Medicine
- Computer literacy
- Mid-level
- Paid holidays
- Health insurance
business development & Admissions representative
Crown Behavioral Health —Columbus, OH
- Full-time
- Hybrid work
- Up to 50% travel
- Marketing
- Hospital
Quick Apply
6d
Community Health Worker
LOWER LIGHTS CHRISTIAN HEALTH CENTER INC —Columbus, OH
- Full-time
- 18 years or older
- Spanish
- Computer literacy
- Paid holidays
- Health insurance
Quick Apply
Interim Biller
WellSpring Counseling —Columbus, OH
- Psychiatry
- Mid-level
- Office
- Employee assistance program
Quick Apply
OFFICE MANAGER FOR A HOME HEALTH AGENCY
Pennell Healthcare LLC —Columbus, OH
- From $18.50 an hour
- Overtime
- HIPAA
- Mid-level
- Office
Quick Apply
6h
Buisness Operations Manager
WellSpring Counseling —Columbus, OH
- Office
- Senior level
- Employee assistance program
Quick Apply
Court Case Manager - CDCA
BASECAMP RECOVERY LLC —Columbus, OH
- Full-time
- Clean driving record
- HIPAA
- Mid-level
Quick Apply
Sales and Marketing Specialist
Otterbein SeniorLife —Johnstown, OH
- Part-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Dental insurance
Quick Apply
13d
Patient Care Technician-PCT
Fresenius Medical Care —Columbus, OH
- Full-time
- Inventory control
- Heavy lifting
- High school diploma or GED
- Paid training
- Health insurance
Patient Care Technician - PCT
Fresenius Medical Care —Columbus, OH
- 12 hour shift
- Inventory control
- Heavy lifting
- Outpatient experience
- Paid training

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Utilization Management Specialist

ST VINCENT FAMILY SERVICES
Columbus, OH

Quick Apply

Job Details

Full-time
6 days ago

Benefits

Paid time off
401(k) matching

Qualifications

Associate's degree

Full Job Description

At St. Vincent Family Services, it's our job to help families build bright futures. Make it your job, too!

We offer competitive compensation based on education, experience, licensure, and internal equity, along with comprehensive benefits, 401(k) matching, and a generous PTO package.

These are just a few of the many reasons to join our team.

SUMMARY

The Utilization Management Specialist is responsible for coordinating and managing all prior authorization activities for clinical services across multiple Medicaid Managed Care Organizations (MCOs). This position serves as the primary liaison between St. Vincent Family Services and MCO payors to ensure authorization requests are submitted timely, approved services are tracked accurately, and service disruptions are prevented.

The Utilization Management Specialist monitors client eligibility, tracks authorized units by procedure code, manages authorization renewals, and communicates authorization approvals and denials to treatment teams. This role works closely with clinical staff, program leadership, billing, and MCO representatives to maximize reimbursement, ensure compliance with payer requirements, and support continuity of care for clients.

ESSENTIAL DUTIES & RESPONSIBILITIES

Maintains confidentiality and compliance with HIPAA, agency policies, and payer regulations.
Serves as the primary point of contact for all MCO prior authorization activities.
Monitors and reviews MCO portals to track authorization status, pending requests, approvals, denials, and requests for additional information.
Verifies and documents client eligibility and insurance coverage prior to authorization submission and throughout treatment episodes.
Runs authorization utilization reports and analyzes data to identify clients approaching authorization thresholds.
Maintains an authorization tracking system that includes:
- Authorization numbers
- Approved dates of service
- Procedure codes
- Authorized units
- Units utilized
- Remaining units
- Expiration dates
Monitors service utilization and proactively identify clients nearing authorized unit limits.
Requests completed clinical documentation and authorization forms from treatment providers when renewal thresholds are met.
Reviews authorization packets for completeness and accuracy prior to MCO submission.
Submits initial, concurrent, and reauthorization requests to Medicaid Managed Care Organizations within required timelines.
Coordinates responses to MCO requests for additional documentation or clinical information.
Communicates authorization approvals, denials, partial approvals, and service changes to treatment team members in a timely manner.
Collaborates with program directors, treatment providers, and billing staff to resolve authorization concerns and prevent service interruptions.
Maintains organized electronic records of all authorization submissions, determinations, and correspondence.
Tracks authorization denial patterns and communicates trends to leadership.
Assists with audits, quality assurance activities, and compliance reviews related to authorization management.
Develops and maintains productive working relationships with MCO representatives.
Participates in department meetings, training, and process improvement initiatives.
Performs other duties as assigned.

QUALIFICATIONS

Education and/or Experience:

Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Minimum of two years of experience in healthcare authorization management, utilization management, medical billing, behavioral health administration, or related healthcare setting preferred.

Knowledge, Skills & Abilities:

Strong understanding of behavioral health authorization processes and payer requirements.
Knowledge of Medicaid and Managed Care authorization procedures preferred.
Excellent organizational skills and attention to detail.
Strong analytical skills and ability to interpret utilization and authorization reports.
Ability to manage multiple deadlines and competing priorities.
Ability to communicate effectively with clinical, administrative, and payer representatives.
Ability to maintain accurate records and follow complex payer requirements.
Ability to work independently while functioning as part of a collaborative team.

Technical Skills

Proficiency in Microsoft Outlook, Excel, Word, and Teams.
Ability to learn and navigate multiple MCO portals.
Experience with electronic health records and data management systems.
Ability to generate, analyze, and maintain utilization tracking reports.

WORK ENVIRONMENT

Standard office environment with occasional evenings/weekends for events. Hybrid schedule available after 90-day probationary period.

Requires prolonged sitting and extensive computer use.
Requires manual dexterity sufficient to operate a computer, telephone, and other office equipment.
Requires normal range of hearing and vision to prepare reports and communicate effectively.
May occasionally lift and/or move items up to 15 pounds.

Quick Apply

Refine Your Search

medicaid liaison jobs in columbus

Utilization Management Specialist

Patient Care Representative

Community Health Worker

Financial Counselor

Health Planning Administrator 3 - 20014670

Quality Outreach Coordinator - PFK Clinical Integration

Physician Liaison

Director of Job & Family Services

Case Manager - Foster Care (OH)

Business Office Manager - Senior Living

Medical Science Liaison, Respiratory - Ohio (OH, KY, IN, MI)

business development & Admissions representative

Community Health Worker

Interim Biller

OFFICE MANAGER FOR A HOME HEALTH AGENCY

Buisness Operations Manager

Court Case Manager - CDCA

Sales and Marketing Specialist

Patient Care Technician-PCT

Patient Care Technician - PCT

I want to receive the latest job alert for medicaid liaison in columbus

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