Offer summary

Qualifications:

Bachelor's Degree or relevant experience, Previous healthcare or insurance experience required, Proven ability to collaborate across teams and departments, Organized and detail-oriented..

Key responsabilities:

Serve as the primary patient advocate with insurance

Lead initial reviews with out-of-network insurance companies for pre-certification

Collaborate with intake therapists and patient advocates to gather clinical and benefit information

Complete all levels of appeals and document treatment approvals.

Job description

Weekly outpatient therapy isn't always enough, and a trip to the ER isn't the only answer. Patients and their families rely on Compass Health Center when in crisis – every day, we help people overcome depression, anxiety, suicidality, obsessions/compulsions, trauma, chronic pain, and other obstacles in order for our patients to live freely.

About This Role

As a Utilization Review Specialist focused on Single Case Agreements and Out-of-Network coverage (SCA/OON), you’ll be a vital advocate ensuring patients can access the care they need, regardless of insurance barriers. You’ll take the lead in securing prior authorizations and pre-certifications for mental health partial hospitalization and intensive outpatient services, ideally before or right as a patient begins care. Partnering closely with our clinical, intake, and patient advocacy teams, you’ll navigate insurance conversations with confidence, build strong relationships with payors, and ensure approvals are in place so treatment can start without delay. From initiating reviews to managing appeals, you'll play a key role in making sure patients receive timely, covered care. If you're passionate about patient advocacy and thrive in a fast-paced, collaborative environment, we’d love to have you on our team.

What You’ll Do:

Serve as the primary patient advocate with insurance
Take the lead on all initial reviews with out-of-network insurance companies for pre-certification
Seek the approval of single case agreements and/or out of network exceptions
Collaborating with the intake therapist and patient advocate to collect all relevant and up to date clinical and benefit information for patients
Provide the best presentation or rationale for patient to receive out of network partial or intensive outpatient treatment on an in-network basis
Complete all levels of appeals available (pre-certification and concurrent)
Build and maintain strong relationships with case managers
Work closely with designees from payor contracting and patient advocate team to increase likelihood of successfully obtaining single case agreements and/or an out of network exception
Accurately documenting approval for and authorization for days of treatment in program  
Communicating treatment approvals and schedule additional reviews as needed 
Abide by HIPAA compliance standards

Who You Are:

Proven ability to collaborate across teams and departments
Are able to relay detailed patient information in a compassionate and confidential manner 
Are organized and detail-oriented 
Enjoy a fast-paced, collaborative environment
Bachelor's Degree or relevant experience
Previous healthcare or insurance experience required

We are committed to a fair and equitable work environment. The expected compensation range for this role is below. This range includes multiple career path levels across the organization; where you fall in the range is dependent upon a number of factors including, but not limited to, your years of experience, type of experience, location, and education/certifications. Compass reserves the right to update these ranges.

Compensation

$57,000—$62,000 USD

We know job descriptions can be intimidating, so if this sounds like an opportunity for you, please don't hesitate to apply!

Who We Are

Compass Health Center is a recognized leader in crisis-level mental health, bringing passion, connection, and patient-centered care to the Partial Hospitalization and Intensive Outpatient space (PHP/IOP). Based in Chicagoland, we serve hundreds of patients every day, ranging from ages 5 through adulthood, in our onsite facilities or through our flourishing virtual programming. Compass fills a critical gap between outpatient and inpatient care through an intermediate level of Behavioral Healthcare.

A few more things we want you to know: our values are super important to us, and hopefully will be to you, too. Cultural humility, teamwork, continuous improvement, connection, patient centered care, passion, innovation, and agility should be your power sources. Joining Compass is an opportunity to feel fulfilled through a joint mission towards healing our communities.

Benefits & Perks

We know that you will be dedicated to your purpose here. We look at that investment as a two-way street. We are proud to offer plenty of space for growth, and opportunities to pursue continuous development within our organization.

For eligible positions, our other benefits include: comprehensive medical/dental/vision plans, 401k program with company matching, generous PTO (including competitive parental leave after 1 year of employment), and continuous training through CEU seminars and volunteering opportunities.

What’s Next?

Compass is committed to cultivating diverse and dynamic teams who exude passion for their craft, so whether or not you check all the boxes, we encourage you to apply – we’d be grateful to hear from you!

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