Utilization Manager

Abraxas Youth & Family Services; Woodridge (IL); On-site; USD 54,000 - 66,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

401(k)

Tuition Assistance Program

Paid Time Off

Life Assistance Program

Job summary

A nonprofit human services provider is seeking a Utilization Manager for its Woodridge location. The role involves monitoring concurrent reviews, requesting authorizations, and managing various clinical documentation to ensure compliance with healthcare regulations. Candidates should hold a Bachelor’s degree in a behavioral health field and have at least two years of case management experience. Benefits include medical insurance, a 401(k) plan, and tuition assistance, among other perks.

Qualifications

• 2+ years of behavioral health case management experience.
• Experience working with Medicaid and state-specific healthcare systems.
• CADC, LPC, or LSW required.

Responsibilities

• Monitor and track concurrent reviews for timeliness and content.
• Perform continued stay and retrospective reviews.
• Prepare and submit clinical appeals for inappropriate referrals.

Skills

Behavioral health case management

Hospital utilization review

Collaboration with state agencies

Knowledge of DSM IV

Education

Bachelor's degree in a behavioral health field

Job description

Position

Utilization Manager (UM) – Full time, Salary $60,000 per year

Location

Woodridge Interventions, 2221 64th Street, Woodridge, IL 60517

About Abraxas Youth & Family Services

Abraxas Youth & Family Services is a national nonprofit human services provider dedicated to building better futures for at‑risk youth, adults, and families through education, counseling, in‑home support, shelter, detention, residential treatment, and re‑entry services.

Job Summary

As a Utilization Manager, your primary responsibility is to monitor and track concurrent reviews for timeliness and appropriate content, request additional authorizations, write precertification requests for new admissions, and resolve eligibility and insurance issues.

Essential Duties & Responsibilities

• Review authorizations for placement and referral, including providing referral authorizations, concurrent reviews, proactive discharge and transition planning, and referral to case management.
• Monitor all utilization reports to assure compliance with reporting and turnaround times.
• Perform continued stay and retrospective reviews for movement to another level of care.
• Prepare and submit clinical appeals for inappropriate referrals.
• Impact length of stay and influence use of resources by sharing knowledge with clinical and medical staff and community resources.
• Monitor patient’s clinical progress and coordinate care from admission to discharge.
• Assist clinical staff with chart audits and filing to assure compliance with contract requirements.
• Encourage optimum utilization of medical care, appropriate level of care, and utilization of hospital beds.
• Keep current with regulation changes and inform staff of updates and changes.
• Maintain knowledge of community agencies and services, medical necessity, and clinical criteria for RTC level of care.
• Maintain records associated with the Prison Rape Elimination Act (PREA).
• Attend staff meetings and participate in department activities and programs.
• Implement company policies.
• Maintain knowledge of each client’s problem areas.

Minimum Requirements

• Bachelor’s degree in a behavioral health field.
• Two years of behavioral health case management experience; four years in a related field preferred.
• Experience working with Medicaid and state‑specific behavioral healthcare systems.
• Demonstrated skills in working, communicating, and collaborating with state agencies.
• Hospital utilization review experience or managed care background preferred.
• CADC, LPC, or LSW required.
• Knowledge of the new 2060 regulations and DSM IV.
• Experience providing authorizations and re‑authorizations for patients with substance use disorder (SUD) or mental health (MH) conditions.

Other Qualifications

• At least 21 years of age.
• Valid criminal clearance and background check.
• Valid driver’s license in state of residence.
• Ability to work with computers and the necessary software typically used by the department.

Benefits & Perks

• Medical, Dental, and Vision Insurance
• Flexible Spending Accounts
• Basic Life & Short‑Term Disability Insurance
• 401(k)
• Life Assistance Program (LAP)
• Tuition Assistance Program
• Paid Time Off, Paid Holidays, Paid Training

Equal Opportunity Employer

Abraxas Youth & Family Services is an equal opportunity employer. All employment decisions are made without regard to race, color, religion, sex, national origin, age, sexual orientation, disability, or any other protected characteristic.

Contact

Now Hiring: Utilization Manager (UM) – Woodridge Interventions.