Utilization Management Specialist - Springfield, IL

Who is Gateway Foundation?

Gateway Foundation, Inc. is a national non-profit dedicated to helping individuals with substance use and mental health disorders. Established in 1968, Gateway provides essential tools and knowledge for recovery, positively impacting hundreds of thousands of lives. Operating through its Community Services, Corrections Divisions, and Corporate Headquarters, the organization is recognized for innovative, effective treatment approaches and maintaining high standards.

Why join us?

Consider joining our team, where your impact can be truly meaningful. Our organization focuses on delivering high quality clinical services as a recognized leader in evidence-based treatment proven to get results. By joining our team, you'll have the chance to provide essential services to underserved populations, all while working for an organization that values you and aims to be an employer of choice. You can expect to be part of a vibrant culture that emphasizes teamwork and professional growth. When you join us, you have the opportunity to find both personal and professional fulfillment by aligning your career with your values.

Utilization Management Specialists are responsible for:

• Obtaining initial and subsequent authorizations of clinical services from insurance and government payors
• Reviewing clinical records and determining the appropriateness of patient admission, level of care, continued length of stay, and discharge
• Providing training and support to clinical treatment staff on the insurance authorization process
• Assisting staff with preparing peer-to-peer reviews and clinical appeals by advising them on presenting case information in accordance with established procedures
• Preparing regular summary reports and presentations on utilization management data
• Other duties as assigned

Job Requirements:

• Comprehensive knowledge of treatment planning and behavioral healthcare clinical documentation, therapeutic services, intervention techniques, and medical records review. Bachelor's degree in counseling, nursing or a closely related field. Master's degree preferred.
• Knowledge and familiarity with the utilization management process in order to maximize appropriate treatment as indicated by client needs and comply with regulations, policies and procedures, understanding of diagnoses and ability to collect, analyze and report on utilization management data at a level normally acquired through three to five years progressively more responsible related experience in a healthcare setting.
• Proficiency in computer software applications such as Microsoft Word and Excel to complete required forms, reports, and analyses. Familiarity with electronic health record systems to review patient records and determine appropriateness of patient care.
• Advanced communication skills to effectively present information verbally and in writing and work collaboratively with others to establish single case agreements, identify process improvements, resolve problems and provide effective training.
• Advanced interpersonal skills necessary to provide advice and counsel to managers and employees and to gather and exchange information with a variety of internal and external contacts.
• High level analytical skill necessary to interpret insurance contracts and provisions, determine appropriateness of patient admissions and continued length of stay, and make recommendations to enhance services as needed for individual clients.
• A current and valid driver's license, in order to travel to others sites to participate in trainings and meetings.

Physical Requirements:

• Proofreading and checking documents for accuracy on a continual basis (critical).
• Ability to use a keyboard and video display terminal to receive, retrieve, and/or audit information and data.
• Ability to respond to telephones, pages and speech.
• Normal or corrected vision in order to read and audit files.
• Ability to operate a motor vehicle safely and remain alert to traffic signs and conditions in order to travel to assigned sites.

Compensation (based on experience and credentials):

• Range begins at $51,463 - $82,330/year
• Gateway Foundation conducts annual reviews including merit increases.

Benefits at Gateway Foundation:

Health and Wellness:

• Medical, dental, and vision insurance for employees and dependents
• Employee wellness program promoting health and fitness and offering cash-saving premiums
• Employee assistance programs focused on mental health

Financial Wellbeing:

• 403(b) Retirement Plan with 3% employer match
• Short-term and Long-term Disability and Life and AD&D Insurance paid for by Gateway
• Flexible Spending Accounts for medical and dependent care
• Public Service Loan Forgiveness (PSLF)

Flexibility and Time Off:

• 18 paid time off days per year - accrual rates increase with years of service
• 9 paid company holidays
• Work-life-balance

Personal Development:

• Training & Development Programs
• Tuition Reimbursement - up to $5,250 per calendar year
• eLearning access to online courses that provide CEU's and job-related training
• Clinical Supervision: Formal and informal guidance

Gateway Foundation is an Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets. Please view Equal Employment Opportunity Posters provided by OFCCPhere.