Hartgrove Behavioral Health System consists of a 160-bed leading psychiatric hospital dedicated to providing quality behavioral health services for a diverse population of all ages. A flagship behavioral health facility within Universal Health Services, Inc. and throughout Illinois, Hartgrove is a state-of-the-art facility offering some of the most advanced technologies and programs found in the behavioral health field.

We are seeking a skilled Utilization Management Coordinator for Admissions.

Duties:

• Performs timely, daily pre-certifications, to secure initial authorization based on payer’s criteria and in accordance with the hospital wide Utilization Management Plan.
• Coordinates with the Business Office, Admissions Department and Utilization Management Department.
• Obtains billing and insurance information, verification of benefits, communicates problematic benefit verification with Business Office, etc.
• Update patient accounts to ensure accurate demographic information.
• Advocates on behalf of the patient to ensure the appropriate level of care, including appropriateness of the admission.
• Knowledgeable and able to explain Hospital programs, services, and treatment goals. Understands and considers basic growth and development needs specific to the age and population served.
• Provides accurate and complete information to payers regarding reason for admissions.
• Assures compliance with all applicable laws, codes, rules, and regulations that pertain to psychiatric admissions.
• Trains other staff in the pre-certification process, policies, and procedures.
• Obtains, organizes, and has current information regarding initial authorizations, pending authorizations, and initial denied authorization.
• Maintains all data/records regarding the pre-certification process.
• Participates in the hospital-wide Quality Assurance Program.

Skills:

Education: Bachelor’s degree in behavioral health field required; Master Degree preferred.

Experience: 1 year experience in Utilization Management; 1 year experience in mental health/psychiatry preferred

Knowledge: Working knowledge of Illinois Confidentiality Act, ILPA process and detailed understanding of psychiatric criteria for various levels of care. 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.

This is a full-time position with competitive compensation. We offer a comprehensive benefits package, including health insurance, retirement plans, paid time off, and professional development opportunities. If you are a highly motivated individual with a passion for healthcare, we encourage you to apply.

Job Type: Full-time

Pay: From $51,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Healthcare setting:

• Hospital
• Inpatient

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Education:

• Bachelor's (Required)

Experience:

• Behavioral health: 1 year (Preferred)
• Utilization management: 1 year (Required)

Ability to Relocate:

• Chicago, IL 60644: Relocate before starting work (Required)

Work Location: In person