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Hartgrove Behavioral Health System · 3 months ago

Utilization Management Coordinator - Full Time

Chicago, IL

Full-time

Onsite

Entry Level

1+ years exp

Hartgrove Behavioral Health System is a leading psychiatric hospital dedicated to providing quality behavioral health services. The Utilization Management Coordinator performs clinical reviews to secure treatment authorization, coordinates data collection, and participates in compliance activities while supporting the multidisciplinary treatment team.

Health CareMental Health

Responsibilities

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

Qualification

Utilization ManagementMental Health ExperienceBehavioral Health KnowledgeInsurance ProceduresStatistical AnalysisPatient AdvocacyCommunication SkillsNegotiating Skills

Required

Bachelor's Degree in behavioral health related field required

1 year experience in Utilization Management

1 year experience in mental health/psychiatry

Possesses knowledge of utilization review, insurance and managed care procedures

Current knowledge of regulating/accrediting agency guidelines

Basic knowledge of computer skills and statistical analysis

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