Clinical Utilization & Payer Review Specialist

Universal Health Services, Inc.; Chicago (IL); On-site; USD 60,000 - 90,000; Full time

Job summary

Hartgrove Behavioral Health System, part of Universal Health Services (UHS), seeks a Utilization Management Coordinator to perform daily clinical reviews for various payer types and ensure timely authorization for continued treatment. The role supports a multidisciplinary team and contributes to quality assurance efforts within the hospital.

The position emphasizes accurate data entry in the Midas system, timely communications with providers, and adherence to CMS and regulator guidelines to

Qualifications

• Bachelor's Degree in behavioral health related field required; Master Degree preferred.
• 1+ years of experience in Utilization Management preferred.
• Knowledge of utilization review, insurance and managed care procedures; DSM-V familiarity.
• Effective oral and written communication skills to support patient advocacy and negotiate with payers.

Responsibilities

• Performs timely, daily clinical reviews with all payer types to secure authorization for continued treatment.
• Enters all relevant data in Midas system including certification, denials, Medicare and appeals.
• Educates and guides on level of care requirements and payer expectations for patient acuity and appropriate utilization.
• Communicates with attending provider/other disciplines within 24 hours of identification of problems.
• Participates in hospital-wide Quality Assurance Program and related committees.

Education

Bachelor's Degree in behavioral health related field

Master Degree preferred

Job description

Hartgrove Behavioral Health System, part of Universal Health Services (UHS), seeks a Utilization Management Coordinator to perform daily clinical reviews for various payer types and ensure timely authorization for continued treatment. The role supports a multidisciplinary team and contributes to quality assurance efforts within the hospital.

The position emphasizes accurate data entry in the Midas system, timely communications with providers, and adherence to CMS and regulator guidelines to