Hartgrove Behavioral Health System
Utilization Management Coordinator - Full Time
Hartgrove Behavioral Health System, Chicago, Illinois, United States, 60290
Responsibilities
Utilization Management Coordinator for PHP/IOP (Substance Abuse Services/CADC required) – Full Time (32 hours/week). JOB SUMMARY: Performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer’s criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th party reviewers, effectively coordinating collection of all supporting data to support the hospital and patients’ position. Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization. Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators. Works collectively with hospital operations to ensure timely documentation is aligned with patient conditions. Contributes to monthly utilization data trends using hospital data tools to report for the overall operation. Facilitates physician reviews with payers as required. Maintains all records/data pertaining to the Utilization Management Program. Actively participates in Utilization Management/Medical Records Committee meetings including presentation of reports, statistics, etc. Participates in the hospital-wide Quality Assurance Program. Education and qualifications: Bachelor’s Degree in behavioral health related field required; Master Degree preferred. CADC required. Experience: 1 year experience in Utilization Management and 1 year experience in mental health/substance abuse services required. Knowledge: Possesses knowledge of utilization review, insurance and managed care procedures; current knowledge of regulating/accrediting agency guidelines; basic computer skills and statistical analysis desired; knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines (DSM-V) including substance abuse. Excellent verbal and written communication skills to support patient advocacy and negotiating with payers. EEO Notice: All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and support recruitment, selection, placement, promotion and compensation without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by law. Diversity and inclusion are integral to our success. Notice: At UHS and all its subsidiaries, recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. During recruitment, no recruiter will request financial or personal information via email. If you are suspicious of a job posting, contact the UHS alert line. Qualifications
Job specification: Utilization Management Coordinator for PHP/IOP (Substance Abuse Services/CADC required). Full-Time. The UM Coordinator conducts PHP and IOP admission and concurrent reviews, liaises with 3rd and 4th party reviewers, maintains UM records, and reports denials. Tracks data and participates in UM Committee activities to improve quality of systems related to the UM Plan. Education: Bachelor’s Degree in a behavioral health related field; Master’s Degree preferred. CADC required. Experience: 1 year in Utilization Management and 1 year in mental health/substance abuse services. Knowledge: Utilization review processes, insurance and managed care; DSM-V knowledge for substance abuse; strong communication skills for patient advocacy and payer negotiations. Job Function
Project Management and Information Technology Industries
Hospitals and Health Care; Mental Health Care Location and salary information and other postings are provided for context and market awareness. This listing includes various regional postings and salary ranges that may change over time. Referrals increase your chances of interviewing at Hartgrove Behavioral Health System by 2x. Get notified about new Management Coordinator jobs in Chicago, IL.
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Utilization Management Coordinator for PHP/IOP (Substance Abuse Services/CADC required) – Full Time (32 hours/week). JOB SUMMARY: Performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer’s criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th party reviewers, effectively coordinating collection of all supporting data to support the hospital and patients’ position. Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization. Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators. Works collectively with hospital operations to ensure timely documentation is aligned with patient conditions. Contributes to monthly utilization data trends using hospital data tools to report for the overall operation. Facilitates physician reviews with payers as required. Maintains all records/data pertaining to the Utilization Management Program. Actively participates in Utilization Management/Medical Records Committee meetings including presentation of reports, statistics, etc. Participates in the hospital-wide Quality Assurance Program. Education and qualifications: Bachelor’s Degree in behavioral health related field required; Master Degree preferred. CADC required. Experience: 1 year experience in Utilization Management and 1 year experience in mental health/substance abuse services required. Knowledge: Possesses knowledge of utilization review, insurance and managed care procedures; current knowledge of regulating/accrediting agency guidelines; basic computer skills and statistical analysis desired; knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines (DSM-V) including substance abuse. Excellent verbal and written communication skills to support patient advocacy and negotiating with payers. EEO Notice: All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and support recruitment, selection, placement, promotion and compensation without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by law. Diversity and inclusion are integral to our success. Notice: At UHS and all its subsidiaries, recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. During recruitment, no recruiter will request financial or personal information via email. If you are suspicious of a job posting, contact the UHS alert line. Qualifications
Job specification: Utilization Management Coordinator for PHP/IOP (Substance Abuse Services/CADC required). Full-Time. The UM Coordinator conducts PHP and IOP admission and concurrent reviews, liaises with 3rd and 4th party reviewers, maintains UM records, and reports denials. Tracks data and participates in UM Committee activities to improve quality of systems related to the UM Plan. Education: Bachelor’s Degree in a behavioral health related field; Master’s Degree preferred. CADC required. Experience: 1 year in Utilization Management and 1 year in mental health/substance abuse services. Knowledge: Utilization review processes, insurance and managed care; DSM-V knowledge for substance abuse; strong communication skills for patient advocacy and payer negotiations. Job Function
Project Management and Information Technology Industries
Hospitals and Health Care; Mental Health Care Location and salary information and other postings are provided for context and market awareness. This listing includes various regional postings and salary ranges that may change over time. Referrals increase your chances of interviewing at Hartgrove Behavioral Health System by 2x. Get notified about new Management Coordinator jobs in Chicago, IL.
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