LOCATION: JOHN H. STROGER HOSPITAL / MANAGED CARE - CHICAGO, IL
SHIFT: 9:00 AM - 5:00 PM
The Utilization Management Program Manager is responsible for CountyCare Health Plan's Utilization Management (UM) program and vendor contract oversight for medical, behavioral, Long Term Services and Supports (LTSS), dental, vision, and pharmacy UM. Collaborates with CountyCare directors, clinical managers, providers, and vendors to facilitate appropriate, efficient and effective utilization of health care services in conjunction clinical programs, National Committee on Quality Assurance (NCQA) and State and federal requirements. Serves as UM point of contact providing expertise and analyzing data from various sources to design and implement initiatives resulting in timely and accurate service authorization and cost effective, quality health outcomes for CountyCare.
Bachelor's degree from an accredited college or university is required.(Official transcripts must be provided at time of interview).
Must be licensed in the State of Illinois as a Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or Licensed Clinical Professional Counselor (LCPC).
A minimum of three (3) years of full-time clinical work experience is required.
A minimum of two (2) years of full-time utilization management experience in a health plan or manager of utilization management in a hospital setting is required.
A minimum of one (1) year of full-time experience analyzing utilization and/or claim data using InterQual, Millman and American Society of Addiction Medicine (ASAM) clinical utilization guidelines is required.
Intermediate proficiency using Microsoft Office, including Microsoft Word, Excel and Access (i.e., analyzing and manipulating data in spreadsheets and generating reports) is required.
Must be able to travel to work sites throughout Cook County community agencies, network providers, government and other agency offices .
Must be able to travel to Springfield, Illinois.
Master's Degree in Business, Health Administration, Nursing, or Public Health
Certified Professional Utilization Management (CPUM) or Certified Professional Utilization Review (CPUR)
Two (2) years of full-time management or supervisory experience
Utilization management experience as both a reviewer and manager in a Medicaid Managed Care Organization (MCO)
Case management, disease management, and/or quality improvement experience in a Medicaid (MCO)
Experience working with integrated behavioral and physical health care
Experience with Utilization Review Accreditation Commission (URAC) and/or National Committee for Quality Assurance (NCQA) accreditation
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must :
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question,
As one of the largest public health systems in the country, the Cook County Health and Hospitals System (CCHHS) cares for more than 300,000 individuals resulting in over 1 million patient visits each year. Our mission to care for all, regardless of their ability to pay, dates back to 1835. In that time, we have cared for millions of patients and trained thousands of doctors, nurses and health pro...fessionals. We conduct important research making substantial contributions to current practices. With a patient-centric focus, we look to our teams to provide a commitment to leading edge practices and approaches, collegial relationships and the CCHHS mission.