Acadia Healthcare Behavioral Health Utilization Review Manager in Lemont, Illinois

RESPONSIBILITIES

  • Demonstrates understanding of the medical criteria for the differing levels of care.

  • Initiates initial authorization with network providers.

  • Maintains knowledge of clinical information by review of documentation, participation in staffing, attending care conferences and collaborating with other members of the treatment team.

  • Performs concurrent review with network providers.

  • Monitors medical record documentation using knowledge of established guidelines to promote compliance and further ensure quality for retrospective review by external review entities.

  • Acts as liaison with physician and other treatment team members to:

  • Assures that all aspects of treatment are fully documented

  • Assists in identifying options for care

  • Assures a seamless flow of information between levels of care by collaborating with the admissions department, clinical and financial departments, residents’/families/guardian to provide a smooth transition

  • Assures coordination of resources with other community services and agencies.

  • Duties as assigned.

QUALIFICATION/SKILLS

  • Master’s degree or equivalent in Human Services preferred.

  • Current and active Illinois clinical licensure or Illinois active endorsement to license.

  • At least two years of clinical experience in case management and/or utilization review preferred.

  • Demonstrated expertise considering patient age, gender, developmental level and cultural/religious issues.