Garfield Park Behavioral Hospital · 9 hours ago
Utilization Management Coordinator- Full time
Chicago, IL
Full-time
Onsite
Entry Level
1+ years expGarfield Park Behavioral Hospital is dedicated to providing behavioral health and psychiatric support to children and teens. The Utilization Management Coordinator will perform clinical reviews to secure authorization for treatment and serve as a liaison to various reviewers, while also participating in quality assurance and data reporting activities.
Child CareHealth CareHospitalWellness
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
Required
Bachelor's Degree in Behavioral Health Field required
1 year experience in Utilization Management
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
Preferred
Master Degree preferred
1 year experience in mental health/psychiatry preferred
Company
Garfield Park Behavioral Hospital
Garfield Park Behavioral Hospital provides psychiatric programs and adolescents programs.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Alyce Mondy
Chief Financial Officer
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