Job Title

LTE Senior Mental Health Counselor Utilization Review and Intake SpecialistRecruitment began on June 17, 2025 and the job listing Expires on July 31, 2025 Waukesha County’s Department of Health & Human Services is recruiting for a talented LTE Senior Mental Health Counselor.The Utilization Review and Intake Specialist is one of the first points of contact for patients at the Waukesha County Mental Health Center and Crisis Resource Center. This position will: Complete routine, frontline administrative work necessary- working with patients to complete all necessary forms, gathering demographic and insurance information, obtaining prior authorizations, entering information into the medical records system, and communicating with others to ensure patient insurance is set up appropriately in the electronic record and billing system Obtain prior authorizations and continued stay authorizations Collaborate with internal and external stakeholders to support the patient and ensure high-quality, cost-effective care Use nationally recognized, evidence-based guidelines to review appropriateness of admission and provision of care based on the patient’s clinical condition(s) Communicate with insurance companies and/or payer to obtain admission authorization and continued stay certification or recertification in a professional and timely manner Document utilization reviews and payer contact communication outcomes Evaluate and facilitate concurrent and retrospective prior authorization denials, appeals, or payment issues until resolved to ensure proper reimbursement is received Provide recommendations to providers and works with the healthcare team to ensure proper documentation utilization of care and to support medical necessity for hospital stay in the electronic medical record in accordance with regulatory standards Serve as a resource to medical staff on issues related to admission qualifications, resource utilization, national and local coverage determinations, and documentation improvement opportunities Communicate payer issues and medical necessity concerns with healthcare team to ensure appropriate care is provided Identify and escalate trends with insurance companies, denials, documentation/order requirements, or medical necessity concerns. Identifies and escalates quality concerns related to clinical care to leadership as appropriate Actively contribute to and participates in utilization review and fiscal meetings or committees as assigned Assists patients with referrals to the Moraine Lakes Consortium, or to the appropriate staff for insurance coverage This position requires the ability to change focus at a moment’s notice as necessary, therefore patience, professionalism, empathy, and multi-tasking skills are required. Previous mental health, prior authorization, and utilization review management knowledge and experience is necessary. This is an in-office position with scheduled hours of 8:00 am-4:30 pm. This is an LTE, non-benefited position. Business casual work attire is allowed. In-office events are held throughout the year. Minimum Training & Experience Requirements For work assignments in utilization review and benefit verification the following may be substituted: 1) Bachelor’s degree from a recognized college or university with a major in sociology, social work, psychology, or a closely related field. OR 1) Graduation from a recognized nursing program with active Registered Nurse licensure. 2) Two years of full-time experience in a health or human service field.#J-18808-Ljbffr