Utilization Management Specialist

Universal Health Services; Chicago (IL); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Competitive wages

Shift differentials

Career advancement

Job summary

Hartgrove Behavioral Health System, part of Universal Health Services, seeks a Utilization Management Coordinator to perform daily clinical reviews and secure authorizations for continued treatment across payer types. This role coordinates with 3rd/4th party reviewers and contributes to hospital-wide utilization and quality assurance efforts.

The position requires a Bachelor's in a behavioral health field; Master’s preferred, with knowledge of CMS guidelines and utilization review processes.

Qualifications

• Bachelor's Degree in behavioral health related field required; Master Degree preferred.
• LCPC, LCSW, LPC, LSW, LMFT, RN or CADC preferred.
• Knowledge of utilization review, insurance and managed care procedures.

Responsibilities

• Performs timely, daily clinical reviews with all payer types to secure authorization for continued treatment.
• Enters data in Midas system including certification, denials, Medicare and appeals.
• Communicates with attending provider and other disciplines within 24 hours of identifying problems related to unmet criteria.

Skills

Oral and written communication

Education

Bachelor's Degree in behavioral health

Master's Degree preferred

LCPC/LCSW/LPC/LSW/LMFT/RN or CADC preferred

Job description

Hartgrove Behavioral Health System, part of Universal Health Services, seeks a Utilization Management Coordinator to perform daily clinical reviews and secure authorizations for continued treatment across payer types. This role coordinates with 3rd/4th party reviewers and contributes to hospital-wide utilization and quality assurance efforts.

The position requires a Bachelor's in a behavioral health field; Master’s preferred, with knowledge of CMS guidelines and utilization review processes.