Utilization Manager

Full job description

Hiring: Utilization Manager

Location: Woodridge Interventions | 2221 64th St. | Woodridge, IL 60517

Now hiring a Utilization Manager at Woodridge Interventions

The primary function of the Utilization Manager is to monitor and track concurrent reviews for timeliness and appropriate content to request additional authorization. In addition, the Utilization Manager will assist in writing precertification requests for new admissions, monitoring and resolving eligibility issues and other health insurance issues.

At Woodridge Interventions, our job is helping others. We need passionate, talented people working together who share our desire to provide the best quality care to our patients.

Required certification or license: CADC, LPC, LCPC, LSW or LCSW

Salary Range: $60,000 to $65,000 Annually

Job Type: Full-Time

Qualifying Employer for the Public Service Loan Forgiveness (PSLF) program.

Benefits & Perks: We provide a competitive and comprehensive benefits program that offers the protection, peace of mind and flexibility designed to support you – both at home and at work.

• Medical & Dental & Vision Insurance
• Flexible Spending Accounts
• Basic Life & Short-Term Disability Insurance
• 401(k)
• Life Assistance Program (LAP)
• Tuition Assistance Program
• Paid Time Off (PTO) * Paid Holidays * Paid Training
• Advancement Opportunities

Essential Functions:

• Prepares and submits prior authorizations
• Reviews and prepares concurrent reports
• Performs certification activities through continued-stay and retrospective reviews to third party payers and regulatory agencies, thus maintaining denial rates. Prepares and submits clinical appeals if and when denied
• Impacts length of stay and influences use of resources by sharing knowledge with physician practices, payers, agencies and community resources
• Monitors patients' clinical progress and coordinates patient care from admission to discharge.
• Assist with chart audits and filing as needed
• Encourage optimum utilization of medical care, appropriate level of care and utilization of hospital beds
• Serves as resource person for members of the healthcare team, patients, and caregivers.
• Maintain current knowledge of community agencies and services, medical necessity and clinical criteria for RTC level of care including ASAM criteria
• Provides education regarding third party payers and regulatory agency requirements for reimbursement
• Attends staff meetings and participates in department activities and programs
• Independently manages an established caseload on a daily basis, assists other staff members with high/low census, provides coverage after normal working hours or weekends as facility needs indicate
• Communicates effectively with clients, support services, and co-workers; uses communication systems effectively (i.e. Communication Log, E-Mail, Shift Plans, Feedback Log, Status Recommendation Sheet, Incident Reports)
• Implements Abraxas policies on professional expectations, code of conduct and other practices and procedures.
• Supports the Abraxas philosophy and mission and promotes the Seven Key Principles of care.

Non-Essential Functions:

• None

Minimum Requirements:

• The following educational requirements are acceptable for this classification including:
• Bachelor's degree in behavioral health field and two years of behavioral health case management experience; four years' experience in related field preferred.
• Experience working with Medicaid and state-specific behavioral healthcare systems, and demonstrated skills in working, communicating, and collaborating with state agencies; hospital utilization review experience or managed care background preferred.
• Valid Licensed Professional Counselor (LPC) or Licensed Clinical Professional Counselor (LCPC) in the State of Illinois or CADC.
  • Other Qualifications:
    • At least twenty-one (21) years of age.
    • Criminal clearances and background check.
    • Valid driver's license from employee's state of residence.
    • Valid registered vehicle insurance.
  • Ability to work with computers and the necessary software typically used by the department.

Who We Are:

Abraxas Youth & Family Services is a national nonprofit human services provider dedicated to Building Better Futures for at-risk youth, adults, and families. Our diversified array of services includes alternative education, outpatient counseling, in-home services, shelter, detention, residential treatment and re-entry/transition services.

Since 1973, Abraxas team members have positively impacted the lives of those we serve and the communities in which they live.

Why Should You Consider Abraxas?

• At Abraxas, we celebrate the richness of our diverse employees and the communities we serve. We are actively committed to building a culture of awareness and belonging, as we strive to ensure we are a welcoming, inclusive, and culturally competent organization.
• As we work to make a difference in people's lives, we are dedicated to respect, equity, and the engagement of those we serve and our employees.
• As a provider of trauma-informed care, we firmly believe in recovery and that our clients can lead fulfilling and meaningful lives, and we consider it an honor and a privilege to assist them in their journey.
• Whether you're looking to begin a rewarding career or you're a seasoned professional wanting a new challenge, we have a place for you and opportunities for development at all levels.
• At Abraxas, everything we do centers around people. That is why we are committed to providing you with competitive pay and comprehensive benefit options that help make your life easier and healthier, with a focus on providing choice when it comes to physical, emotional and financial wellness. Our benefit options meet you where you are in your life and set you up for success both in and outside of work.
• If you want to have a positive impact in the lives of others, come join us!

Equal Opportunity Employer

Abraxas Youth & Family Services, an affiliate of Apis Services Inc., offers a rewarding career for those passionate about making a difference in the lives of others. Abraxas is a great place to start your career whether you have a high school diploma or GED, military experience, some college, or a bachelor or advanced degree. If you are interested in counseling, juvenile justice, psychology, social work, teaching or just want to make a difference, we have a career path for you.

We are Hiring and We Want You on Our Team!

Interested in joining our outstanding team? If you have any questions, you can contact us by email at