A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
Lincoln Prairie Behavioral Health Center - 3.0 Springfield, IL Job Details Full-time $37.55 - $56.33 an hour 13 hours ago Benefits Health insurance Dental insurance Paid time off Vision insurance 401(k) matching Loan forgiveness Pet insurance Qualifications Staff supervision Case assessment RN License Managed care organization experience DSM-5 Master's degree Team management Healthcare team management Hospital regulatory compliance
Full Job Description Responsibilities:
Lincoln Prairie Behavioral Health Center is a 97-bed facility located in Springfield, Illinois. We are dedicated to providing youth with compassionate mental health treatment that encourages self-responsibility and personal growth. We are the only facility of our kind in Central Illinois! We provide psychiatric treatment to children and adolescents that present with a broad range of psychiatric and behavioral disorders. A clinically skilled multidisciplinary team works to partner with the youth and family to accomplish their goals in a supportive and therapeutic environment. The Utilization Review Director oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration. Supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement.
Qualifications:
Duties and Responsibilities:
Oversees all utilization management functions. Oversees precertification, concurrent, and discharge utilization reviews. Facilitates regulatory compliance by ensuring proper documentation and allocation of treatment resources. Serves as a key member of the hospital management team. Acts as a key participant in hospital operations meetings that drive financial and clinical results. Functions as a key liaison with all hospital physicians to align physician engagement with payer expectations, patient acuity and discharge planning requirements. Leads payer engagement activities including post payment reviews, payer audit oversight and denial/appeal oversight. Directs utilization management staff and performs all administrative department head functions. Oversees the Utilization Management committee structure. Develops and monitors utilization management plans. Benefit & Rewards Highlights Retention Bonus Program Loan Forgiveness Program Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan SoFi Student Loan Refinancing Program Tuition savings Career development opportunities within UHS and its 300+ Subsidiaries! Pet Insurance More information is available on our
Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation. Experience using data to identify trends. Ability to manage team productivity and compliance with required timelines. Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations. Excellent oral and written communication skills that drive departmental hospital engagement. 8-10 years of experience working in an acute inpatient psychiatric setting as a treatment team member or 5-7 years of experience in utilization management for both mental health and substance abuse behavioral health disorders.
Education :
Master's Degree required Registered Nurse License required Social Work, Marriage and Family, Mental Health Counseling (i.e.
LPC, LMHC, LCSW, LCPC, LPCC
) preferred 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. Avoid and Report Recruitment Scams We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.
