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Case Manager Coordinator
3 weeks ago
NEW LIFE CENTERS OF CHICAGOLAND NFP Chicago, United States**Position Summary** · The Case-Manager Coordinator position is full-time, 40 hours per week (non-exempt, benefits available) and will take place at our various locations. The Case-Manager Coordinator is part of a Resiliency team of Victim Advocates and Case-Managers who have a p ...
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Manager, Care Coordination
2 weeks ago
TAPESTRY 360 HEALTH Chicago, United StatesThe Care Coordination Manager is a working Care Coordinator who leads the Care Coordination program. They delegate tasks based on resources and needs, ensure there is adequate clinic coverage and monitor MHN ACO performance indicators. They are also involved in organization-wide ...
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Owner Management Coordinator
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CVR Associates Chicago, United StatesResponsible for being the link between Housing Choice Voucher Program participating owners and the Chicago Housing Authority. Acts as a liaison between HCV owners assisting them in navigating the program to assist in a positive partnership. · **Essential Duties**: · - Reconcile t ...
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Utilization Management Coordinator
3 days ago
Hartgrove Behavioral Health System Chicago, United StatesHartgrove Behavioral Health System consists of a 160-bed leading psychiatric hospital dedicated to providing quality behavioral health services for a diverse population of all ages. A flagship behavioral health facility within Universal Health Services, Inc. and throughout Illino ...
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Coordinator/project Manager
6 days ago
Northeastern Illinois University Chicago, United StatesNortheastern offers a rewarding working environment for our students and employees. Our faculty and staff are smart, dedicated people who work to create an excellent urban university experience for bright and motivated students. · Job Summary: · The Project Manager (PM) is respon ...
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Regional Order Management Coordinator
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Spirax Sarco Chicago, United States**Regional Order Management Coordinator** · Be a customer advocate and ensure the delivery of excellent customer service through communication and coordination with cross-functional work partners. Demonstrates the ability to work in a fast-paced environment at a high level of eff ...
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Project Manager, Care Coordination
2 weeks ago
South Side Healthy Community Organization Chicago, United StatesThe** Project Manager, Care Coordination** in partnership with the Director of Care Coordination and Manager, Care Coordination, will work to develop and implement SSCHO Care Coordination models and workflows. The Project Manager will develop the overall workplan, track milestone ...
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Utilization Management Appeals Coordinator
3 days ago
Hartgrove Behavioral Health System Chicago, United StatesHartgrove Behavioral Health System consists of a 160-bed leading psychiatric hospital dedicated to providing quality behavioral health services for a diverse population of all ages. A flagship behavioral health facility within Universal Health Services, Inc. and throughout Illino ...
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Cook County Health & Hospitals System Chicago, United States**PATIENT ACCESS QUALITY MANAGEMENT COORDINATOR** · **Job Number**: ** · **Job Posting**: Apr 9, 2024, 10:37:46 AM **Closing Date**: Apr 23, 2024, 11:59:00 PM · Full-time **Shift Start Time**: 8:00 A.M. **Shift End Time**: 4:00 P.M. · **Collective Bargaining Unit**: AFSCME 1111 · ...
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Infinity Ventures Loop, United StatesAbout FD InvestConsult GmbH: · Together in our corporate group, we combine four leading companies in building technology - ibb Burrer & Deuring Ingenieurbüro Gmbh ⋅ Schindler Consult Ingenieurgesellschaft mbH ⋅ Rentschler und Riedesser Ingenieurgesellschaft mbH für Technik im Bau ...
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Revenue Management Specialist/Coordinator
2 weeks ago
Hornblower Group Chicago, United StatesRevenue Management Specialist/Coordinator - City Cruises · Job Category · : · Sales & MarketingRequisition Number · : · REVEN010492Apply nowPosted : February 20, 2024Full-TimeLocations · Showing 1 locationChicago, IL, USA · Description · City Cruises is seeking a Revenue ...
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Revenue Management Specialist/Coordinator
2 weeks ago
Hornblower Inc Chicago, United StatesCity Cruises is seeking a Revenue Management Specialist/Coordinator for our Sales operation in Chicago, IL. · About You: · This person will be adaptable, have superior attention to detail, and embody City Experiences' RESPECT Service System. · About the Opportunity: · The suc ...
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Project Manager/Coordinator
3 weeks ago
Talent Software Services Chicago, United StatesProject Manager/Coordinator · Job Summary: Talent Software Services is searching for a Project Manager/Coordinator for a contract-to-hire position in Chicago, IL(Hybrid). The opportunity will be six months with a strong chance for a long-term extension. · Position Summary: Perf ...
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Utilization Management Coordinator
3 weeks ago
Universal Health Services Chicago, United States Full timePerforms timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payers criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th Management, Behavioral Health, ...
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Manager, Care Coordination
2 weeks ago
TAPESTRY 360 HEALTH Chicago, United StatesJob Description · Job DescriptionThe Care Coordination Manager is a working Care Coordinator who leads the Care Coordination program. They delegate tasks based on resources and needs, ensure there is adequate clinic coverage and monitor MHN ACO performance indicators. They are al ...
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Utilization Management Appeals Coordinator
4 days ago
Hartgrove Behavioral Health System Chicago, United States Full timeJob Description · Responsibilities · JOB SUMMARY: Responsible for all denial and appeal activities for the Utilization Management department, including Expedited Appeals, Standard Appeals, External Independent Reviews, Retrospective Reviews, and State Fair Hearings. Review cl ...
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Case Management Coordinator
22 hours ago
C Vs Pharmacy Chicago, United StatesBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — ...
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Senior Care Coordination Manager
3 weeks ago
The University of Chicago Medicine Chicago, United StatesJob Description: · The Center for Transformative Care (CTC) at the University of Chicago Medicine (UCM) supports the development and deployment of UCMs efforts and clinical programs related to value-based care. The goal of the CTC is to help UCM succeed in the transformation into ...
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Project Manager, Care Coordination
22 hours ago
South Side Healthy Community Organization Chicago, United StatesAbout the Organization · The South Side Healthy Community Organization (SSHCO) is non-profit organization built as a collaborative of 13 healthcare organizations - safety net hospitals, health systems and Federally Qualified Health Centers - on the South Side of Chicago. Support ...
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Utilization Management Appeals Coordinator
3 weeks ago
Universal Health Services Chicago, United States Full timeResponsible for all denial and appeal activities for the Utilization Management department, including Expedited Appeals, Standard Appeals, External Independent Reviews, Retrospective Reviews, and State Fair Hearings. Review clinical information for a Appeals, Management, Behavior ...
utilization management coordinator - Chicago, IL , USA, United States - UHS
Description
Responsibilities
JOB SUMMARY:
Performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer's criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th party reviewers, effectively coordinating collection of all supporting data to support the hospital and patients' position. Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization. Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators. Works collectively with hospital operations to ensure timely documentation is aligned with patient conditions. Contributes to monthly utilization data trends using hospital data tools to report for the overall operation. Facilitates physician reviews with payers as required. Maintains all records/data pertaining to the Utilization Management Program. Actively participates in Utilization Management/Medical Records Committee meetings including presentation of reports, statistics, etc. Participates in the hospital-wide Quality Assurance Program.
Qualifications
JOB SPECIFICATIONS:
To perform this job successfully, an individual must be able to perform each primary duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.
Education:
Bachelor's Degree in Behavioral Health Field required; Master Degree preferred.
Experience:
1 year experience in Utilization Management; 1 year experience in mental health/psychiatry preferred
Licensure/Certification:
None
Knowledge:
Possesses knowledge of utilization management, insurance and managed care procedures. Current knowledge of regulating /accrediting agency guidelines. Basic knowledge of computer skills and statistical analysis desired. Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines - Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers.