Seeking full-time Utilization Management Specialist Downers Grove
Our client a large health network is seeking a full time UM Specialist for their professional office in Downers Grove, IL. This is a full time temporary to hire position. All interested candidates must have the following skills and knowledge.
- Performs the day-to-day tasks of: entering referrals, applying criteria (where necessary), authorizing or denying services, as appropriate, and documenting in the computer system according to internal policies and procedures
- Meets or exceeds Referral Department productivity targets on a weekly basis.
- Maintains files and records of referral activity
- Coordinates and data enters authorizations and cases for Case Managers.
- Assists with cross coverage within the referral management team as assigned.
- Works aggressively with physicians and physician office staff to obtain necessary medical information related to referral requests
- Ensures integration of Referral Management activities with other areas of Medical Management: Compliance, Case Management, and Quality Management.
- Communicates and works with Members, Member Services, Provider Relations, Management, Medical Leadership and Administration
- Minimum Associates degree required
- 2-4 years of UM Experience required
- Knowledge of healthcare industry – Health Plan, MSO, CMS, Federal regulations
- Ability to maintain the highly confidential nature of member Personal Health Information (PHI)
- CPT and IDC-9 coding familiarity
- Must be familiar with accreditation standards (JCAHO, NCQA, and NPDB, preferred)
- Knowledge of Medical Terminology
If you or anyone you know is qualified and interested in the position, please send an updated resume to us ASAP for immediate review and consideration.