Illinois Licensed Market Appeals Specialist

Job Summary

To support utilization management within the behavioral health division, the fully remote Illinois Licensed Market Appeals Specialist will manage standard appeals, liaise with facilities and payers for timely processing, and participate in local facility meetings to enhance appeal outcomes.

Key responsibilities

• Complete all standard appeals in a timely manner and manage appeal inventory through tracking and monitoring
• Act as a liaison with local facilities and payers to ensure timely processing of appeals and follow-up for facility reimbursement
• Provide feedback to providers and the UM team on opportunities impacting facility recoveries

Required qualifications

• Bachelor's degree required; Master's preferred
• RN License or Master's level clinician required; licensure preferred
• 3-5 years of related experience required; 5-8 years preferred
• Knowledge of utilization management operations and payer engagement
• Proficient in Excel, Microsoft Office/Teams, Word, and database inventory management