Student Veterans of America Jobs

Welcome to SVA’s jobs portal, your one-stop shop for finding the most up to date source of employment opportunities. We have partnered with the National Labor Exchange to provide you this information. You may be looking for part-time employment to supplement your income while you are in school. You might be looking for an internship to add experience to your resume. And you may be completing your training ready to start a new career. This site has all of those types of jobs.

Here are a few things you should know:
  • This site is mobile friendly. You do not need a log-in or password to access information.
  • Jobs on this site are original and unduplicated and come from three sources: the Federal government, state workforce agency job banks, and corporate career websites. All jobs are vetted to ensure there are no scams, training schemes, or phishing.
  • The site is refreshed daily to remove out-of-date content.
  • The newest jobs are listed first, so use the search features to match your interests. You can look for jobs in a specific geographical location, by title or keyword, or you can use the military crosswalk. You may want to do something different from your military career, but you undoubtedly have skills from that occupation that match to a civilian job.
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Job Information

Universal Health Services Utilization Management Appeals Coordinator - Full time in CHICAGO, Illinois

Responsibilities

JOB SUMMARY: Responsible for all denial and appeal activities for the Utilization Management department, including Expedited Appeals, Standard Appeals, External Independent Reviews, Retrospective Reviews, and State Fair Hearings. Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested. Prepare letters for member and provider appeals that did not meet criteria. Gather, analyze, and report information regarding member and provider appeals. Maintain files and logs for all appeals. Follow all appeals and retrospective reviews through resolutions. Remain current on applicable UM trends and regulations and review current policies and procedures for compliance. Work closely with the Business Office to ensure proof of authorization and denials communicated accurately in Midas. Interface with various managed care organizations and other payers to resolve issues related to appeals. Maintains all records/data pertaining to the Utilization Management Program. Actively participates in Utilization Management/Medical Records Committee meetings including presentation of reports, statistics, etc. Participates in the hospital-wide Quality Assurance Program.

Qualifications

JOB SPECIFICATIONS: To perform this job successfully, an individual must be able to perform each primary duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.

Education: Bachelor’s Degree in behavioral health related field required; Master Degree preferred.

Experience: 1 year experience in Utilization Management and 1 year experience in mental health/psychiatry preferred.

Knowledge: Possesses knowledge of utilization review, insurance and managed care procedures. Current knowledge of regulating /accrediting agency guidelines. Basic knowledge of computer skills and statistical analysis desired. Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines - Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers.

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