Supervisor, Utilization Management

Texoma Medical Center; Orlando (FL); Presencial; USD 70 000 - 90 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Competitive compensation

Generous paid time off

Excellent medical, dental, vision and药

401(k) with company match

SoFi student loan refinancing

Tuition savings with Chamberlain

Career development opportunities

Pet insurance

Resumo da oferta

Central Florida Behavioral Hospital in Orlando, FL is seeking a UM Supervisor who reports to the Director of Utilization Management. The role provides oversight for UR staff and ensures compliance with medical necessity and regulatory standards.

The position emphasizes reviewing patient records, managing denial letters, and maintaining adherence to Joint Commission, CMS, EMTALA, HIPAA, and related guidelines within a private psychiatric setting.

Qualificações

• Master’s degree in social work or mental health field or equivalent for licensure.
• Two years of experience with external review organizations in chart analysis and UR.
• Ability to work independently and set priorities.
• Valid FL license: RN, LCSW, LMHC, LMFT preferred.

Responsabilidades

• Ensure protocol for clinicians to review the patient’s medical records on specific days to meet continued authorization.
• Ensure staff knowledge regarding medical necessity, regulatory requirements and standards (Joint Commission, Title 9, CMS/Medicare, EMTALA, HIPAA).
• Oversee UR activities, including written appeal letters for denials.

Conhecimentos

Independent work

Communication with external review org

Formação académica

Master’s degree in social work or mental health field

Descrição da oferta de emprego

Responsibilities

Central Florida Behavioral Hospital is a 174-bed, private psychiatric center located in Orlando, FL. The hospital provides 24-hour emergency services. Central Florida Behavioral Hospital offers a full continuum of care including inpatient treatment services for children, adolescents and adults; and partial hospitalization, intensive out-patient and ECT services for adults. Our treatment philosophy is based on a team approach that treats patients with dignity and respect, while delivering high-quality care.

Website: www.centralfloridabehavioral.com

Click here for a Virtual Facility Tour

Position Summary

Under the direction fo the Director, Utilization Management, the UM Supervisor p provide oversight for the staff and work performed in the UR Department.

Job Duties/Responsibilities

• Ensure protocol for clinicians to review the patient’s medical record on specific days to meet continued authorization.
• Ensure knowledge of staff regarding medical necessity, regulatory requirements and standards, i.e. Joint Commission, Title 9, CMS/Medicare guidelines, EMTALA, HIPAA, etc.
• Oversee processes and procedures for all UR activities, including written appeal letters for denials

Benefit Highlights

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Tuition savings to continue your nursing education with Chamberlain University
• Career development opportunities within UHS and its 300+ Subsidiaries!
• Pet Insurance
• More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

Headquartered in King of Prussia, PA, Universal Health Services, Inc. (NYSE: UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services. Since our founding in 1979, UHS has grown steadily into a premier Fortune 500® corporation perennially recognized by multiple esteemed national rating entities. Through its subsidiaries, UHS operates inpatient acute care facilities, inpatient behavioral health facilities, outpatient and other facilities, nationwide virtual behavioral health services, an insurance offering, a physician network and various related services with physical locations in the U.S., Puerto Rico, Ireland and United Kingdom. www.uhs.com.

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Qualifications

• Master’s degree required from an accredited college or university in social work, mental health related field or equivalent for licensure.
• A minimum of two (2) years' experience with communication with external review organizations in chart analysis and UR field required.
• Ability to work independently and set priorities.
• Valid FL license: RN, LSCW, LMHC, LMFT preferred.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.