Utilization Management Clinical Assistant

NorthShore University HealthSystem; Warrenville (IL); On-site; USD 31,000 - 46,000; Full time

Benefits offered by this job

Premium pay

Incentive pay

Tuition Reimbursement

Free Parking

Paid Time Off

Health plan options

Job summary

NorthShore University HealthSystem in Warrenville, IL, is seeking an Utilization Management Clinical Assistant to support the Utilization Review workflow. You will conduct precerts, discharge reviews, and insurance follow-up calls to help manage patient care and approvals.

The role requires a Bachelor's degree, familiarity with behavioral health, and experience with insurance appeals. Proficiency in Microsoft Office and familiarity with DSM-IVR criteria are preferred.

Qualifications

• Bachelor's degree required.
• Proficiency in Microsoft Office products.
• Familiarity with behavioral health field, terminology and levels of care.
• Knowledge of DSM IVR (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria.
• Experience completing and submitting insurance appeals.
• Knowledge of insurance benefits, authorization requirements, and payer appeal processes.

Responsibilities

• Demonstrates the knowledge and skills necessary to provide care appropriate to the age of patients served.
• Understands where to locate information in the chart or clinic documentation.
• Completes discharge reviews.
• Checks charges, attendance functionality, and notes to check outpatient days attended.
• Supports authorization processes by completing authorization by any necessary means.
• Identifies cases for the Financial Appeals Log and Clinical Appeals Log.
• Assists in coordinating appeal efforts prior to discharge.
• Reviews Appeals Log and writes reconsideration letters to insurers.
• Updates Appeals Log statistics and prepares UM Committee data.
• Makes follow-up calls to insurance companies on status of pending appeals.

Skills

Behavioral health knowledge

Insurance appeals experience

Payer appeal processes understanding

Education

Bachelor's Degree Required

Tools

Microsoft Office

Insurance systems (billing portal)

Job description

Hourly Pay Range:

$22.14 - $33.21 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.

Position Highlights:

• Position: Utilization Management Clinical Assistant
• Location: LOH- Corp Center- Warrenville, IL
• Full Time/Part Time: Full Time (40 hours)
• Hours: Monday-Friday
• Required Travel: N/A

A Brief Overview:

Supports the Coordinator, Utilization Review by assisting with the workflow which includes conducting precerts and discharge reviews, preparing appeals and completing insurance follow up calls on status.

What you will do:

• Demonstrates the knowledge and skills necessary to provide care appropriate to the age of patients served. T
• his includes knowledge of the physical and psychological needs of patients served and the ability to respond appropriately to those needs.
• Understands where to locate information, if needed to present case specific information, by means of the chart or clinic documentation.
• Completes discharge reviews.
• Checks charges, attendance functionality , and notes to check outpatient days attended. Sends missing charge emails to Billing Specialist as necessary.
• Supports ancillary details of authorizations by completing authorization by any means necessary (live/telephonic, chart support, fax or portal).
• Identifies new cases to be added to the Financial Appeals Log.
• Adds cases identified from paperwork and/or Utilization Review Coordinators to Clinical Appeals Log for tracking purposes.
• Assist in coordinating appeal efforts prior to patient's discharge.
• Supports identifying integral denial/appeal/approval paperwork to identify for scanning purposes or distribution or charting purposes.
• Reviews the Appeals Log for inpatient/partial hospitalization program/intensive outpatient program cases and read through the clinical documentation for the patient case. Writes letter to insurance organization requesting reconsideration for their denial of services.
• May participate in contributing with any needed pieces for recredentialing applications or contracts.
• Updates Appeals Log statistics.
• Prepares data for the UM Committee meeting minutes as needed.
• Makes follow-up phone calls to insurance companies on status of pending appeals.
• Coordinates with Business Office and Coordinators, Utilization Management regarding benefit issues/questions as needed.
• Coordinates with Billing & Collection Specialist for quarterly reporting presentations and adds UM appeals statistics to presentation.

What you will need:

• Bachelors Degree Required
• Proficiency in Microsoft Office products
• Familiarity with behavioral health field, terminology and levels of care
• Knowledge of DSM IVR (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria
• Experience completing and submitting insurance appeals.
• Knowledge of insurance benefits, authorization requirements, and payer appeal processes.

Benefits (For full time or part time positions):

• Premium pay such as shift, on call, holiday and more based on an employee's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

At Endeavor Health, we are united by a shared commitment to working together to create a culture of connection and belonging-each of us bringing different skills and experiences as we deliver safe, seamless, and personal care. Every person, every time. We are committed to fostering an environment where all team members can be their best, learn, and pursue excellence together.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.