Clinical Utilization Review Specialist

Universal Hospital Services Inc.; Hollys Mill (VA); On-site; USD 60,000 - 90,000; Full time

Job summary

The Hughes Center, part of Universal Health Services, seeks a Utilization Review Coordinator to support resident-centered care in a structured psychiatric residential program for youth ages 10–22. The role coordinates referrals, authorizations, and payor communications, ensuring timely transitions through residential care.

Work Monday–Friday, dayshift, with responsibilities including reviewing clinical data, preparing UR reports, and collaborating with physicians, treatment teams, and payors to

Qualifications

• Bachelor's degree required; master's preferred (Social work, Counseling, Nursing).
• Minimum of three (3) years direct clinical experience in a psychiatric or mental health setting.
• Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
• Must have basic computer skills. Licensure: LMHC, LPC, LMSW, LCSW, or RN preferred.

Responsibilities

• Facilitates communication regarding resident treatment process and needs with referral sources and payor.
• Keeps accurate records of the authorizations for residents in treatment.
• Ensures coordinated effective resident care including admission, continued stays, and discharge requirements.
• Ensures positive relationships with external and internal customers.
• When appropriate, travel to resident’s community representing the facility at FAPT meetings and court hearings.
• Ensures continued availability (recertification) of financial resources throughout the residents’ stay.
• Develop systems to review and respond to concerns expressed by customers and resolve issues with the relevant department head.
• Review clinical patient data with third party reviewers to substantiate the need for continued hospital level of care.

Skills

Clinical experience

Data analysis

Communication

Initiative

Education

Bachelor's degree

Master's degree preferred

Job description

The Hughes Center, part of Universal Health Services, seeks a Utilization Review Coordinator to support resident-centered care in a structured psychiatric residential program for youth ages 10–22. The role coordinates referrals, authorizations, and payor communications, ensuring timely transitions through residential care.

Work Monday–Friday, dayshift, with responsibilities including reviewing clinical data, preparing UR reports, and collaborating with physicians, treatment teams, and payors to