Utilization Management Appeals Coordinator - Chicago, United States - Hartgrove Behavioral Health System

Hartgrove Behavioral Health System
Hartgrove Behavioral Health System
Verified Company
Chicago, United States

1 week ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

Hartgrove 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 Illinois, Hartgrove is a state-of-the-art facility offering some of the most advanced technologies and programs found in the behavioral health field.

We are seeking a skilled
Utilization Management Coordinator.

Duties:


  • 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 hospitalwide Quality Assurance Program.

Skills:


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


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.

This is a full-time position with competitive compensation. We offer a comprehensive benefits package, including health insurance, retirement plans, paid time off, and professional development opportunities. If you are a highly motivated individual with a passion for healthcare, we encourage you to apply.


Pay:
From $51,000.00 per year


Benefits:


  • 401(k)
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Healthcare setting:

  • Hospital
  • Inpatient

Schedule:

  • 8 hour shift
  • Day shift
  • Monday to Friday

Education:


  • Bachelor's (required)

Experience:


  • Behavioral health: 1 year (preferred)
  • Utilization management: 1 year (required)

Ability to Relocate:

  • Chicago, IL 60644: Relocate before starting work (preferred)

Work Location:
In person
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