Utilization Manager

Overview

Location:

Woodridge Interventions, 2221 64th Street, Woodridge, IL 60517

Salary: $60,000 per year

Job Type: Full-time

Required: CADC, LPC or LSW

As a Utilization Manager (UM), your primary function is to monitor and track concurrent reviews for timeliness and appropriate content, to request additional authorization. In addition, the Utilization Manager will assist in writing precertification requests for new admissions, monitoring and resolving eligibility issues and other health insurance issues.

Abraxas Youth & Family Services is a national nonprofit human services provider dedicated to Building Better Futures for at-risk youth, adults, and families. Our diversified array of services includes alternative education, outpatient counseling, in-home services, shelter, detention, residential treatment and re-entry/transition services.

Since 1973, Abraxas team members have positively impacted the lives of those we serve and the communities in which they live.

We provide a competitive and comprehensive benefits program that offers the protection, peace of mind and flexibility designed to support you – both at home and at work.

• Medical & Dental & Vision Insurance
• Flexible Spending Accounts
• Basic Life & Short-Term Disability Insurance
• 401(k)
• Life Assistance Program (LAP)
• Tuition Assistance Program
• Paid Time Off (PTO)
  • Paid Holidays
  • Paid Training
• Advancement Opportunities

• Reviews authorizations for placement and referral which includes providing referral authorizations, concurrent reviews, proactive discharge and transition planning and appropriate referral to case management.
• Monitors all utilization reports to assure compliance with reporting and turnaround times.
• Performs continued stay and retrospective reviews for movement to another level of care.
• Prepares and submits clinical appeals for inappropriate referrals.
• Impacts length of stay and influences use of resources by sharing knowledge with clinical and medical staff as well as community resources.
• Monitors patient’s clinical progress and coordinates patient care from admission to discharge.
• Assists clinical staff with chart audits and filing to assure compliance with contract requirements.
• Encourages optimum utilization of medical care, appropriate level of care and utilization of hospital beds.
• Keeps current with regulation changes and informs staff of updates and changes.
• Maintains current knowledge of community agencies and services, medical necessity and clinical criteria for Residential Treatment Center (RTC) level of care.
• Demonstrates knowledge of and maintains records associated with Prison Rape Elimination Act (PREA).
• Attends staff meetings and participates in department activities and programs.
• Implements Company policies.
• Maintains knowledge of each client’s problem areas.

• Bachelor’s degree in behavioral health field and two years of behavioral health case management experience; four years experience in related field preferred.
• Experience working with Medicaid and state-specific behavioral healthcare systems, and demonstrated skills in working, communicating, and collaborating with state agencies; hospital utilization review experience or managed care background preferred.
• CADC, LPC or LSW Required.
• Must have knowledge of the new 2060 regulations and DSM IV, plus experience providing authorizations and re-authorizations for patients with SUD/MH patients.

• At least twenty-one (21) years of age.
• Criminal clearances and background check.
• Valid driver’s license from employee’s state of residence.
• Ability to work with computers and the necessary software typically used by the department.

Abraxas is committed to building a culture of awareness, belonging, respect, equity and the engagement of those we serve and our employees. We provide competitive pay and comprehensive benefit options focused on physical, emotional and financial wellness.

Abraxas Youth & Family Services, an affiliate of Apis Services Inc., offers a rewarding career for those passionate about making a difference. We provide equal employment opportunities and comply with all federal, state and local laws.

Now Hiring:
Utilization Manager