Utilization Management Support Specialist

Endeavor Health; Warrenville (IL); On-site; USD 31,000 - 46,000; Full time

Benefits offered by this job

Shift pay

On-call pay

Holiday pay

Annual increases

Career growth

Tuition reimbursement

Free parking

Wellness program

Health savings account options

Retirement options with company match

Paid time off

Job summary

Endeavor Health in Warrenville, IL is seeking an Utilization Management Clinical Assistant to support the UM Coordinator by handling precerts, discharge reviews, and insurance follow-up calls on status.

This full-time role requires a Bachelor's degree, strong Microsoft Office skills, familiarity with behavioral health, and experience with insurance appeals. The position involves coordinating authorizations, maintaining logs, and preparing data for UM committee meetings.

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, 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.
• 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.

Skills

Familiarity with behavioral health

DSM criteria knowledge

Education

Bachelor's Degree

Tools

Microsoft Office

Job description

Endeavor Health in Warrenville, IL is seeking an Utilization Management Clinical Assistant to support the UM Coordinator by handling precerts, discharge reviews, and insurance follow-up calls on status.

This full-time role requires a Bachelor's degree, strong Microsoft Office skills, familiarity with behavioral health, and experience with insurance appeals. The position involves coordinating authorizations, maintaining logs, and preparing data for UM committee meetings.