Administrative Support, Case Management/Social Services, Medical & Health
4 Year Degree
The Women's Treatment Center provides chemically dependent women with a continuum of care, recovery tools, and parenting skills to maintain a sober lifestyle as they rebuild their lives and futures and mend the bonds with their families. We are one of the few substance abuse programs in the nation that can accommodate children in residential treatment, making us particularly responsive to the needs of chemically dependent mothers. We are looking for a Utilization Management Specialist to complete medical necessity reviews. The Utilization Management Specialist is responsible for establishing medical necessity criteria which in the opinion of TWTC clinical leadership, is reasonably needed to prevent the onset or worsening of an illness, behavioral health condition, or disability. The clinical review for the appropriate level of care will interface with external payor UM contacts of managed care organizations. Closely coordinate with physicians and TWTC staff for admission and discharge planning and customer service for all ASAM level 2 or 3 and recovery community services. Work with management and staff to ensure quality management standards are maintained through review and analysis of records. Document initial days authorized and concurrent reviews.
Requires a Bachelor’s degree from an accredited educational program in Social Work, Clinical/Counseling Psychology, or Nursing; Master's level preferred.
RN, LPN, LSW, LCSW, LMFT, LPC, or LCPC preferred.
Quality management training or experience required.
Working knowledge of ASAM and other Illinois Medicaid Medical Necessity Criteria; applies principles to internal chart audits to recommend the appropriate level of care placement.
National Committee on Quality Assurance (NCQA) and Utilization Review Accreditation Committee (URAC) Milliman and/or Interqual experience are highly desirable.
Minimum one (1) year experience working with a managed care system.
The knowledge base in Medicaid, Medicare, and commercial managed care systems.
Presentation of medical necessity.
Strong interpersonal skills and ability to work both independently and with physicians, and clinical staff.