• Utilization Review Specialist

    Posted on January 22, 2019 by in
    January 21, 2019
    Hoffman Estates
    Job Type
    Certification Type
    Company Name
    The SHARE Program, A Program of Leyden Family Service
    Your Name
    Jill Wilson
    Address 1
    1776 Moon Lake Blvd


    Leyden Family Service and Mental Health Center

    The SHARE Program


    The SHARE Program is a JCAHO accredited, non-hospital based, residential substance abuse treatment facility located in Hoffman Estates. We are seeking a candidate for full-time Utilization Review Specialist.

    Job Duties Include:

    Advocate on the clients’ behalf for the best treatment & care

    Initiate and complete all pre-authorization reviews for RTC treatment

    Perform all concurrent reviews for RTC treatment

    Provide discharge clinical to insurance providers

    Complete Biopsychosocial Assessments

    Conduct all levels of the appeal process including reconsideration reviews, retroactive reviews, peer reviews, and written appeal letters

    Coordinate with other departments including Intake, Detox, Business Office, and Clinical staff

    Report to Inpatient Supervisor

    Respond to other duties that may be assigned

    Required Skillset:

    Communicate medical necessity effectively & concisely to insurance providers

    Ability to multitask and be very organized

    Ability to toggle between computer screens, have a discussion, and take written notes simultaneously

    Manage time effectively & resourcefully

    Professional phone etiquette

    Required Qualifications:

    LPC or LSW


    6 months to 1 year of previous Utilization Management experience

    A minimum of 6 months experience in a substance abuse treatment facility, preferably Inpatient or PHP level of care

    Familiarity with insurance companies including PPO, HMO, and Managed Care policies




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