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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, Are you a Military Veteran?
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable.
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Pension Plan and Deferred Compensation Program
Employee Assistance Program
Paid Holidays, Vacation, and Sick Time
You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER
Cook County Health & Hospitals System is a public worldwide leader in medical care, research and education. Mission-driven. Patient-focused. Team-based. At CCHHS, nearly 6,000 dedicated professionals — working in every medical and surgical specialty — collaborate to provide health and hope and healing to people from all walks of life.Respect — Whether on the front lines of patient care or support...ing the efforts of your colleagues and co-workers, the work you do at Cook County Health and Hospitals System will help to save lives. You are a valued member of the team.Growth — At Cook County Health & Hospitals System you’re encouraged to build on your strengths and career goals.Diversity — County Health & Hospitals System actively seeks to bring together individuals with diverse thoughts, ideas and backgrounds and to promote an inclusive environment that will generate innovation, greater job satisfaction and, most importantly, continually improved patient care.