Utilization Management Specialist (15317)

Lake County IL Waukegan , IL 60079

Posted 2 months ago

Do you want a career where you can truly make a difference? The Lake County Health Department and Community Health Center is one of the largest human service providers in Lake County. We live our mission each day, promoting the health and well-being of all who live, work, and play in Lake County. If you are passionate about giving back and ready to be a part of an innovative team, we are looking for you!

About the Role:

This position is responsible for performing prior authorization, admission reviews and concurrent reviews with managed care organizations and other insurance companies for services rendered in the Substance Use, Prevention, and Recovery (SUPR) Programs.

Location: 2303 Dodge Ave, Waukegan, IL

Hours: 20 hours a week, (Monday-Friday) 9:00am-1:00pm

FLSA STATUS: Hourly

Skills and Experience

  • Obtains initial and subsequent/concurrent authorizations for clinical services from managed care organizations and insurance companies.

  • Completes thorough documentation in all client accounts (EPM/EHR) of approved or denied authorizations as well as clear communication of the approval/denial information to clinicians.

  • Researches, follows-up and resolves any open or pending authorization requests in a timely manner.

  • Communicates with the payors for status updates on all outstanding and pending authorization requests.

  • Tracks and communicates to clinician's authorization thresholds on all client accounts.

  • Notifies and assists clinicians with subsequent authorization submissions prior to an authorization expiration in order to omit any lapses in coverage and maximize revenue.

  • Accurately analyzes any explanations of benefits with claims denials received in order to resolve any outstanding authorization issue(s) and assist business office with claims payment.

  • Responds in a timely manner with professionalism and courtesy to all inquiries (telephonic and in-person) from payors, clinicians and clients.

  • Establishes and maintains cooperative relationships with LCHD staff, managed care organizations, and insurance companies to facilitate program's continual success.

Education, Qualifications, and Certification:

  • Associate degree required. Major in Behavioral Health, Addiction, Chemical Dependency or related field preferred.

  • Previous experience in Utilization Management or Case Management preferred.

  • Certification as an Alcohol/Drug Abuse Counselor (CADC) by the Illinois Alcohol and Other Drug Abuse Professional Certification Board (I.A.O.D.A.P.C.A.) or equivalent certification by a similar state or national board required.

About the Perks:

Lake County offers a competitive salary and benefit package with performance-based incentive plans. We also offer flexible working hours, and a comprehensive wellness and training program. Visit the Health Department page to get additional information on why you should work for us.

If you would like to learn more about our community impact and to see some of our employees in action, please review this short video.

Any offer of employment is conditioned on the successful completion of a background screening, drug and alcohol testing and may include a pre-employment medical exam.

The Lake County Health Department and Community Health Center is an Equal Opportunity Employer. We evaluate qualified applicants without regard to race, color, religion, sexual orientation, gender identity or gender expression, national origin, disability, veteran status and other protected characteristics.


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Utilization Management Specialist (15317)

Lake County IL