Utilization Management Coordinator - Full Time

UHS•Chicago, IL

130d

About The Position

Hartgrove Behavioral Health System is a 160-bed leading psychiatric hospital dedicated to providing quality behavioral health services for its diverse population of children, adolescents and adults. Hartgrove Hospital has become the flagship behavioral health facility within Universal Health Services, Inc., its parent company. As a leader in behavioral health within UHS and in the Chicago area, Hartgrove Hospital is a state-of-the-art facility offering some of the most advanced technologies and programs found in the behavioral health field. We are dedicated to our teamwork approach and provide a compassionate and therapeutic environment, as well as offering a continuum of specialty programs throughout our inpatient, partial and outpatient services. Utilization Management Coordinator for PHP/IOP (Substance Abuse Services/CADC required)- Full Time (32 hours/week) The Utilization Management Coordinator is responsible for conducting PHP and IOP admission and concurrent reviews in accordance with the hospital wide Utilization Management Plan. The PHP/IOP UM Coordinator serves as a liaison to 3rd and 4th party reviewers and conducts focused reviews as determined by the Utilization Management Committee. The PHP/IOP UM Coordinator maintains all records/data required through the UM Plan and Committee and appeals denied authorizations of dates of services when medical necessity for continued care is evident. The PHP/IOP UM Coordinator tracks and reports denials in MIDAS, participates in staff/physician education relative to medical record documentation and actively participates in the UM Committee by tracking data and trends to be reviewed in order to improve the quality of systems as it relates to the UM Plan.

Requirements

Bachelor’s Degree in behavioral health related field required; Master Degree preferred. CADC required.
1 year experience in Utilization Management and 1 year experience in mental health/substance abuse services required.
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 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) including substance abuse.
Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers.

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.