Utilization Management Specialist - Springfield, IL

Gateway Foundation Inc • Springfield, IL

95d • $51,463 - $82,330

About The Position

Utilization Management Specialists are responsible for obtaining initial and subsequent authorizations of clinical services from insurance and government payors. They review clinical records and determine the appropriateness of patient admission, level of care, continued length of stay, and discharge. The role also involves providing training and support to clinical treatment staff on the insurance authorization process, assisting staff with preparing peer-to-peer reviews and clinical appeals by advising them on presenting case information in accordance with established procedures, and preparing regular summary reports and presentations on utilization management data. Other duties may be assigned as needed.

Requirements

• Current IL licensure as a Registered Nurse; or Masters’ degree in social work, psychology, mental health or substance abuse counseling and certification (CADC) or licensure (LPC, LSW, LCPC or LCSW) in the state of Illinois required
• 1+ years of experience with the utilization management process in a healthcare setting
• This is a full-time position working Monday – Friday, daytime hours

Responsibilities

• Obtaining initial and subsequent authorizations of clinical services from insurance and government payors
• Reviewing clinical records and determining the appropriateness of patient admission, level of care, continued length of stay, and discharge
• Providing training and support to clinical treatment staff on the insurance authorization process
• Assisting staff with preparing peer-to-peer reviews and clinical appeals by advising them on presenting case information in accordance with established procedures
• Preparing regular summary reports and presentations on utilization management data
• Other duties as assigned

Benefits

• Medical, dental, and vision insurance for employees and dependents
• Employee wellness program promoting health and fitness and offering cash-saving premiums
• Employee assistance programs focused on mental health
• 403(b) Retirement Plan with 3% employer match
• Short-term and Long-term Disability and Life and AD&D Insurance paid for by Gateway
• Flexible Spending Accounts for medical and dependent care
• Public Service Loan Forgiveness (PSLF)
• 18 paid time off days per year – accrual rates increase with years of service
• 9 paid company holidays
• Work-life-balance
• Training & Development Programs
• Tuition Reimbursement - up to $5,250 per calendar year
• eLearning access to online courses that provide CEU’s and job-related training
• Clinical Supervision: Formal and informal guidance

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Master's degree
• Number of Employees: 11-50 employees