Utilization Coordinator

Universal Health Services; Forest Park (IL); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Riveredge Hospital, Inc. in Forest Park, IL seeks an Utilization Management Coordinator to lead UM staff, optimize reimbursement workflows, and ensure compliance with state and federal standards.

The role emphasizes collaboration with finance and clinical teams, overseeing admission reviews, concurrent reviews, and reports, and guiding staff through policies and procedures.

Qualifications

• Bachelor’s degree required; Master’s degree preferred.
• Background in mental health to secure reimbursement.
• Knowledge of funding sources and government reimbursement protocols.
• Minimum 2–3 years supervisory experience.
• Understands UM data from admission, reviews and appeals.
• Knowledge of JC, CMS, Illinois Mental Health Code and regulations.
• Strong verbal and written communication skills.

Responsibilities

• Oversee daily activities of the Utilization Management staff, including assigning and scheduling.
• Review and approve documentation and reports.
• Advise and mentor UM staff; oversee work processes, forms, and billing.
• Assist with hiring, coaching, and counseling staff; ensure compliance with policies.
• Conduct UM Committee meetings, staff meetings, in-services, and participate in performance improvement teams.

Skills

Supervisory experience

UM data management

Regulatory knowledge

Funding knowledge

Communication skills

Education

Bachelor's degree

Master's degree preferred

Job description

Responsibilities

Shape the future of behavioral health care throughout the Forest Park community by joining our extraordinary team at Riveredge Hospital. Bring your compassion, expertise, enthusiasm, and passion for quality to a place that cultivates wellness and inspires hope.

We are currently seeking an Utilization Management Coordinator position for Riveredge Hospital. Simply apply to the posting and discuss your interests with the hiring manager if you are selected to come in for an interview.

The Utilization Management Coordinator position oversees the daily activities of the Utilization Management staff including but not limited to assigning and scheduling; reviewing and approving documentation and reports; advising and mentoring UM staff; and overseeing operational procedures involving work processes, forms, and billing. Assists with hiring, coaching, and counseling staff and compliance with internal policies and outside governmental and regulatory agencies. Conducts the Utilization Management Committee meetings, staff meetings, in-services, and participates in performance improvement teams.

Qualifications

• Must have a Bachelor’s degree, Master’s degree preferred.
• Must have an appropriate background in the mental health field to organize and achieve quality performance with a focus on securing reimbursement for the organization.
• Possess an in depth knowledge of funding sources and government reimbursement protocols.
• A minimum of 2-3 years supervisory experience.
• Thoroughly understands the management of UM data obtained from admission, concurrent reviews and appeals utilizing the Severity of Illness/Intensity of Service Criteria.
• Has knowledge of JC, CMS, Illinois Mental Health Code Act, and all other relevant state and federal regulatory standards.
• Possesses strong verbal and written communication skills.