Utilization Management Coordinator- Full time

Position Overview

Garfield Park Behavioral Hospital is dedicated to providing behavioral health and psychiatric support to children and teens ages 3 to 17. Above all else, we treat every patient with compassion and respect. The position available is for a Utilization Management Coordinator - Full Time.

Key Responsibilities

• Performs timely, daily clinical reviews with all payer types to secure authorization for initial and continued treatment in accordance with the hospital-wide Utilization Management Plan.
• Serves as liaison to 3rd and 4th party reviewers, coordinating the collection of supporting data to substantiate the hospital and patients’ positions.
• Educates and guides the multidisciplinary treatment team on level of care requirements and payer expectations regarding patient acuity and appropriate utilization.
• Completes quality and timely appeal/denial letters and participates in post claim recovery reviews and audit activities to ensure regulatory compliance.
• Collaborates with hospital operations to ensure documentation is timely and aligned with patient conditions, and contributes to monthly utilization data trends and reporting.
• Facilitates physician reviews with payers as required and maintains all records related to the Utilization Management Program.
• Participates in Utilization Management/Medical Records Committee meetings, including the presentation of reports and statistics, as well as the hospital-wide Quality Assurance Program.

Required Qualifications

• Education: Bachelor’s Degree in Behavioral Health Field required.
• Experience Required: 1 year of experience in Utilization Management.
• Qualifications: Demonstrated knowledge of utilization management, insurance, and managed care procedures, including familiarity with regulating and accrediting agency guidelines. Must possess basic computer skills, statistical analysis abilities, and effective oral and written communication skills.

Preferred Qualifications

• Education: Master Degree preferred.
• Experience Required: Additional experience in mental health/psychiatry is preferred.

Benefits & Perks

• Benefits: Please visit UHS Benefits Service Center for details.