Utilization Review Coordinator Jobs in Springfield, IL

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place.

Job Description:

Administrator

Sign on Bonus $10K

At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there’s no place like home, and that’s why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their health journey, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as Administrator. Being a part of something this great starts by carrying out our mission every day through your true calling: developing an amazing team of compassionate and dedicated healthcare providers.

To continue to be an industry pioneer in delivering unparalleled care, we need an Administrator with commitment and compassion. Are you one of them? If so, apply today!

Why Join the Elara Caring mission?

• Work in a collaborative environment.
• Be rewarded with a unique opportunity to make a difference
• Competitive compensation package
• Tuition reimbursement for full-time staff and continuing education opportunities for all employees at no cost
• Opportunities for advancement
• Comprehensive insurance plans for medical, dental, and vision benefits
• 401(K) with employer match
• Paid time off, paid holidays, family, and pet bereavement
• Pet insurance

As an Administrator, you’ll contribute to our success in the following ways:

Administrator Responsibilities:

• Organizes and directs the day-to-day operations and maintains a liaison amongst the governing body/owner or personnel.
• Oversees the implementation and oversight of all patient care programs and achievement of both clinical and administrative outcomes.
• Oversees the financial performance of branches falling within the Administrator’s provider number. Implements an effective budgeting and accounting system that promotes the health and safety of the agency’s patients. 
• Ensures adequate staffing levels at branch locations to meet patient needs.
• Ensures compliance of current Medicare, Medicaid, and third-party reimbursement regulations and changes. Identifies and reports potential payment/coverage problems.
• Supervises and coordinates utilization review activities.
• Participates in strategic development of Key Accounts, including participation in weekly, monthly, and quarterly review meetings, as needed.
• Ensures accuracy of all public information, materials, and activities.
• Maintains availability by phone as directed by company policy or regulatory requirement.
• Participates in on-call rotations as scheduled.
• Identifies need for changes in program and services, develops proposals for consideration by Area Vice President or other supervisors, as appropriate.
• Investigates complaints and problems, ensures problem resolution and correction of deficiencies, and reports results to the Area Vice President.

Compliance Responsibilities:

• Ensures all documentation is accurate, complete, timely and adheres to Medicare guidelines.
• Assures compliance with the requirements of state licensure, Medicare certification, and any other applicable oversight agencies through policy and procedure development, staff education, and ongoing monitoring activities.
• Oversees the development of and implementation of plan of corrections in conjunction with state, federal, internal, or other auditing or regulatory bodies.
• Assures all QAPI recommendations are followed in branch locations for improvement of patient care or operational needs.

Leadership & Professionalism:

• Directs all aspects of operations and care delivery in accordance with the mission and values, legal and regulatory requirements, payer and accreditation standards, customer expectations, and agency policy.
• Approves and submits time and attendance files to payroll for processing, including final review of inputs (e.g., visits, mileage, hours worked, etc.) and corresponding rates (e.g., hourly rate, mileage reimbursement rate, pay-per-point scale, etc.).
• Implements the organization’s strategic and growth-related plans.
• Conducts staff performance appraisals accurately and in accordance with Elara Caring policy.
• Develops emergency preparedness plans appropriate to their branch(es)
• Maintains patient and staff privacy and confidentiality pursuant to HIPAA Privacy Final Rule.
• Performs other duties/projects as assigned.

What is Required?

• Current State License as required by state or federal guidance
• Licensed physician, registered nurse or holds an undergraduate degree
• 3+ years healthcare experience required.
• 1+ year supervisory or administrative experience in home health care or related healthcare program required
• Demonstrates familiarity and understanding of national standards of care, state licensure and federal conditions of participation.
• Must be able to travel to offices within region on a regular and frequent basis.
• Must have reliable transportation, a valid driver’s license and auto insurance in accordance with state laws. 
   

• Illinois Administrators:
  • Administrator must have experience in health service administration; and one (1) year supervisory or administrative experience in home health care or in related health provider program; and one of the following degrees:
  • Registered professional nurse; or
  • Individual with an undergraduate degree; or
  • Qualified Public Health Administrator as contained in §600.300 of the Certified Local Health Department Code

You will report the Area Vice President

The base salary for this position is $110-115K Base, based on the company’s good faith estimate at the time of posting. Actual pay will be determined based on factors such as education, experience, skills, and internal equity.

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Equal Employment Opportunity: We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic. If you require assistance due to a disability in the application or recruitment process, please submit a request via email at recruiting@elara.com.

Pay & Benefit Information: Compensation for this role will be determined based on a variety of factors, including qualifications, skills, competencies, and relevant experience. Elara offers a broad range of benefits. Learn more at https://careers.elara.com/us/en/benefits

EVerify: Elara Caring participates in E-Verify after a job offer is accepted and Form I-9 completed.