Utilization Review Jobs in Wheaton, IL (NOW HIRING)

Responsibilities
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 Review Coordinato r is responsible for conducting PHP and IOP admission and concurrent reviews in accordance with the hospital wide Utilization Management Plan. The PHP/IOP UM Coordinator serves as a liaison to 3rd and 4th party reviewers and conducts focused reviews as determined by the Utilization Management Committee. The PHP/IOP UM Coordinator maintains all records/data required through the UM Plan and Committee and appeals denied authorizations of dates of services when medical necessity for continued care is evident. The PHP/IOP UM Coordinator tracks and reports denials in MIDAS, participates in staff/physician education relative to medical record documentation and actively participates in the UM Committee by tracking data and trends to be reviewed in order to improve the quality of systems as it relates to the UM Plan.
Job Duties:

• Conducts admission and concurrent reviews for Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) following the hospital-wide Utilization Management Plan.

• Serves as a liaison to third-party and fourth-party reviewers.

• Performs focused reviews as determined by the Utilization Management Committee.

• Maintains all records and data required by the Utilization Management Plan and Committee.

• Appeals denied authorizations for dates of service when the medical necessity for continued care is evident.

• Tracks and reports denials within the MIDAS system.

• Participates in staff and physician education regarding medical record documentation requirements.

• Contributes to the Utilization Management Committee by tracking data and trends to improve systems quality.

Benefit & Reward Highlights:
A Career with Hartgrove Behavioral Health System Offers....

• A rewarding career improving the lives of adults and youth
• Highly competitive wages & shift differentials
• Career advancement and mobility
• An engaged leadership team with a commitment to patient and staff safety
• And much more!

For information about the benefits we offer, please visit UHS Benefits Service Center .
About Universal Health Services
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom
Qualifications
Education: Bachelor's Degree in behavioral health related field required; Master Degree preferred. LCPC, LCSW, LPC, LSW, LMFT, RN or CADC required.
Experience: 1 year experience in Utilization Management and 1 year experience in mental health/substance abuse services required.
Knowledge: Possesses knowledge of utilization review, 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) including substance abuse. Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers.
Work Schedule: Full-time, Day shift
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.