Mental Health Utilization & Coverage Specialist

Skyway Behavioral Health; Skokie, Downers Grove (IL, IL); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Disability insurance

401K

Paid time off

Floating holidays

Wellness days

Holiday pay

Paid sick time

Growth opportunities

Job summary

Skyway Behavioral Health in Illinois is seeking a Utilization Review Specialist (URS) to advocate for patients in obtaining insurance coverage for necessary treatment. You will ensure accurate coding, align services with medical necessity, and maintain timely documentation in the EMR.

The role requires strong organizational and communication skills, experience in UR processes, and proficiency with EHR and insurance platforms. Join a team dedicated to trauma-informed care and patient wellbeing.

Qualifications

• Minimum 2 years of experience with utilization review in a health care provider or insurance environment.
• Undergraduate degree or relevant experience; master’s degree in social work or counseling preferred.

Responsibilities

• Completes pre-authorizations, concurrent reviews, and internal UR reviews promptly.
• Verifies accuracy of diagnostic and service codes in documentation.
• Applies codes to support level-of-care determinations and standards.
• Manages reviews and documentation in the EMR system with time efficiency.
• Coordinates appeals and peer-to-peer reviews as needed.
• Communicates with interdisciplinary team and insurers regarding medical necessity.

Skills

Utilization review

Organization

Communication

Microsoft Word/Excel

EHR systems

Education

Undergraduate degree

Master’s degree preferred

Tools

EHR systems

Insurance platforms

Microsoft Excel

Job description

Skyway Behavioral Health in Illinois is seeking a Utilization Review Specialist (URS) to advocate for patients in obtaining insurance coverage for necessary treatment. You will ensure accurate coding, align services with medical necessity, and maintain timely documentation in the EMR.

The role requires strong organizational and communication skills, experience in UR processes, and proficiency with EHR and insurance platforms. Join a team dedicated to trauma-informed care and patient wellbeing.