Utilization Management Specialist

Are you looking to find personal and professional fulfillment, and align your career with your values?

At Gateway Foundation, our employees have an opportunity to make a difference every day by helping people with substance abuse issues gain control of their lives.

Gateway Foundation is a recognized non-profit leader in evidence-based treatment proven to get results. Our experts in Addiction Medicine—including highly educated clinical and medical professionals and expert psychiatrists and nurses—deliver care that never stops. Throughout Gateway’s proud history of helping others, dedicated and professional employees have been vital to accomplishing our life-saving mission.

If you are a collaborative professional who shares our commitment to helping people with substance abuse and mental health issues turn their lives around – GATEWAY IS THE PLACE FOR YOU!

Utilization Management Specialists are responsible for:

• Obtaining initial and subsequent authorizations of clinical services from insurance and government payors
• Reviewing clinical records and determining the appropriateness of patient admission, level of care, continued length of stay, and discharge
• Providing training and support to clinical treatment staff on the insurance authorization process
• Assisting staff with preparing peer-to-peer reviews and clinical appeals by advising them on presenting case information in accordance with established procedures
• Preparing regular summary reports and presentations on utilization management data
• Other duties as assigned

Job Requirements:

• Current IL licensure as a Registered Nurse; or Masters’ degree in social work, psychology, mental health or substance abuse counseling and certification (CADC) or licensure (LPC, LSW, LCPC or LCSW) in the state of Illinois required
• 1 years of experience with the utilization management process in a healthcare setting
• This is a full-time position working Monday – Friday, daytime hours

Physical Requirements:

• Proofreading and checking documents for accuracy on a continual basis (critical).
• Ability to use a keyboard and video display terminal to receive, retrieve, and/or audit information and data.
• Ability to respond to telephones, pages and speech.
• Normal or corrected vision in order to read and audit files.
• Ability to operate a motor vehicle safely and remain alert to traffic signs and conditions in order to travel to assigned sites.

Competitive Compensation and Benefits:

Gateway Foundation values its employees and provides an inclusive and diverse work environment where dedicated employees can make a difference. We are committed to engaging and rewarding our employees in meaningful ways. For eligible employees, we provide a Total Rewards Package that includes:

• Gateway is a qualified employer for Public Service Loan Forgiveness (PSLF)
• Health Insurance - Including a wellness premium incentive opportunity
• Dental & Vision Insurance
• Paid Time Off - Including 18 days of PTO and 9 paid holidays in the first year
• Flexible Spending Accounts and Health Saving Account
• Commuter Accounts
• 403(b) Retirement Plan with company match
• Life and AD&D Insurance
• Short Term Disability (STD) and Long-Term Disability (LTD)
• Employee Assistance Program (EAP)
• Tuition Reimbursement
• Training & Development Programs

Gateway Foundation is an Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets. Please view Equal Employment Opportunity Posters provided by OFCCP here.