Utilization Management Coordinator

• Behavioral Health, Behavioral Health
  - Therapist, Billing, Insurance
  - Claims, Medical Billing, Patient Services, Social Worker
• Day
• 367207
• Hartgrove Behavioral Health System
• USD $58,000.00/Yr.
• USD $75,000.00/Yr.

• CHICAGO, Illinois
• Behavioral Health, Behavioral Health
  - Therapist, Billing, Insurance
  - Claims, Medical Billing, Patient Services, Social Worker
• Day
• 367207
• Hartgrove Behavioral Health System
• USD $58,000.00/Yr.
• USD $75,000.00/Yr.

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.

The Utilization Management Coordinator 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.

• Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on payer’s criteria, within the payer time frames.
• Enters all relevant necessary data in Midas system including certification, denials, Medicare and appeals. Ensures all entries are accurate and entered timely, including all correspondence received
• 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. Active participant in multidisciplinary treatment team meetings.
• Communicates to the attending provider/other disciplines within 24 hours of identification of any problems related to unmet criteria, discharge planning, documentation, etc.
• Communicates with managed care/insurance reviewers on requested clinical updates within 24 hours of the certification date. Facilitating peer reviews with payers as required.
• Performs other duties as assigned/required by this position.

• A rewarding career…