Utilization Review Coordinator

Universal Health Services, Inc.; Forest Park (IL); On-site; USD 70,000 - 100,000; Full time

Job summary

Riveredge Hospital in Forest Park, IL, part of Universal Health Services, Inc., seeks an experienced Utilization Management Coordinator to lead and coordinate UM activities. The role focuses on supervision, documentation review, and ensuring adherence to internal policies as well as state and federal requirements.

Responsibilities include mentoring UM staff, reviewing and approving documentation, and participating in performance improvement initiatives to optimize reimbursement and care quality.

Qualifications

• Bachelor's degree required; Master's preferred.
• Background in mental health to improve quality and secure reimbursement.
• Knowledge of funding sources and government reimbursement protocols.
• Minimum 2–3 years supervisory experience.
• Understanding UM data with Severity of Illness/Intensity of Service criteria.
• Knowledge of JC, CMS, Illinois Mental Health Code and regulatory standards.
• Strong verbal and written communication skills.

Responsibilities

• Oversee daily activities of the Utilization Management staff including assigning and scheduling.
• Advise and mentor UM staff and oversee procedures involving forms and billing.
• Assist with hiring, coaching and counseling UM staff and ensure policy compliance.
• Lead Utilization Management Committee meetings and participate in performance improvement teams.

Skills

Supervisory experience

Verbal and written communication

Regulatory knowledge

UM data management

Leadership/mentoring

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.

TheUtilization 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.