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UTILIZATION MANAGEMENT PROGRAM MANAGER
John H Stroger Hospital
Cook County Health & Hospitals System
Link to this job posting for a detailed job description and application process: https://cookcountyil.taleo.net/careersection/200/jobdetail.ftl?lang=en&job=00120053
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
ABOUT COOK COUNTY HEALTH AND HOSPITALS SYSTEM
The Cook County Health & Hospitals System’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCHHS is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCHHS is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, collaborative health plan and enhancing the patient experience.
Clinical Data Analyst (Job ID: 222805)
AMITA Health, Arlington Heights, IL
- Applies standard, descriptive and inferential analysis methods as appropriate to interpret and report on
- Implements data management procedures compliant with regulatory requirements. Ensures the consistent
implementation of data collection procedures by staff.
- Collaborates on the purchase, testing and implementation of data management/analysis applications and
systems. May develop customized data management tools. Trains staff on implemented tools and applications.
- Develops, implements and evaluates documentation formats, validation tests, data collection methods,
databases and other data recording measures.
- Required: Bachelor's degree in a related field such as healthcare analytics, public health or other healthcare
- Preferred: Master's degree in analytics, predictive analytics or healthcare analytics
- Required: Three or more years of clinical/healthcare experience with an emphasis on analytics including analysis
of payor claims data and electronic medical records.
- Required: Programming proficiency in analytic software and database management software
- Strongly Preferred: Ability to program in SAS or Python
AMITA Health (www.AMITAhealth.org) is a joint operating company formed by Adventist Midwest Health, part of the
Adventist Health System in Altamonte Springs, FL., and Alexian Brothers Health System, a subsidiary of St. Louis-based Ascension. Headquartered in Arlington Heights, IL, AMITA Health is the third largest health system in the state with
more than 12,000 associates committed to delivering the most efficient, highest quality, faith-based care at nine acute and specialty care hospitals and at more than 80 ambulatory/clinic locations. AMITA Health has an extensive provider network of more than 3,000 hospital-affiliated physicians and the AMITA Health Medical Group consists of over 500 multi-specialty employed physicians and associate practitioners, ranking it among the largest regional medical groups. AMITA Health's mission is to extend the healing ministry of Jesus by respecting the faith traditions of the many individuals and families we have been called to serve across suburban Chicago.
How to Apply:
Apply at amitahealth.org
Equal Employment Opportunity
AMITA Health will provide equal employment opportunities (EEO) to all associates and applicants for employment
regardless of race, color, religion, national origin, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.