Impactful Utilization Review Specialist - Care Coordination

Universal Health Services; North Stonington (CT); On-site; USD 60,000 - 76,000; Full time

Benefits offered by this job

Benefits package

Career advancement

401K

Tuition reimbursement

Job summary

Universal Health Services is seeking an Utilization Review Specialist to manage pre-certification, concurrent, and discharge reviews for clients across care levels. The role ensures authorization for admission and continued treatment, coordinating with Admissions, payors, and clinical staff to secure appropriate level of care.

The position requires knowledge of UR processes, insurance plans, and mental health treatment, with strong documentation and computer skills to support timely

Qualifications

• Knowledge of Utilization Review (UR) processes across payor sources (precertification, concurrent reviews, discharge review).
• Knowledge of insurance plans and mental health/chemical dependency treatment.
• Experience or familiarity with UR tracking systems and recordkeeping.
• Computer skills and ability to document accurately in systems.

Responsibilities

• Perform initial precertifications for all levels of care.
• Conduct concurrent reviews on assigned cases.
• Advocate for appropriate level of care based on clinical information.
• Coordinate with admissions, payors, clinicians, and billing on dispositions and changes in care.
• Document and file authorization information accurately and timely.
• Notify UR and Billing of denials and appeals when necessary.
• Participate in monthly UR meetings.

Skills

UR processes knowledge

Insurance plans

Mental health & chemical dependency

Computer skills

Education

Master's degree preferred

Bachelor's degree in Psychology or related Human Service Field or RN

Job description

Universal Health Services is seeking an Utilization Review Specialist to manage pre-certification, concurrent, and discharge reviews for clients across care levels. The role ensures authorization for admission and continued treatment, coordinating with Admissions, payors, and clinical staff to secure appropriate level of care.

The position requires knowledge of UR processes, insurance plans, and mental health treatment, with strong documentation and computer skills to support timely