Utilization Review Clinician

Lighthouse Care Center of Augusta; Augusta (GA); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Referral Bonus Program

Challenging work environment

Competitive compensation

Generous PTO

Excellent Medical, Dental, Vision and药

Job summary

Lighthouse Care Center of Augusta, a 84-bed psychiatric facility in Augusta, GA, seeks a Utilization Review Clinician to join the Case Management team. The role focuses on coordinating clinical data to ensure high-quality, cost-effective treatment in line with UHS standards.

Under UR Manager guidance, you will review medical records, assist with pre-certifications and continued stays, and collaborate with physicians, nurses and therapists to support insurance communications and patient care.

Qualifications

• Masters level education in social science (social work, counseling, sociology, psychology).
• Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC)
• Nurses with a GA or Multistate license encouraged to apply. (LPN, RN)

Responsibilities

• Review clinical content of medical records and coordinate with physicians, therapists and staff to gather data for insurance communication and precertification.
• Input pre-certifications and continued stay reviews into Midas; verify insurance coverage and post patient payments into MS4.
• Train in gathering and entering clinical criteria and related duties.

Education

Master's degree in social science

License-eligible in Georgia (LAPC, LPC, LMSW, LCSW, LMFT, LMHC)

GA-licensed nurse encouraged to apply (LPN/RN)

Tools

Midas

MS4

Job description

Responsibilities

Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15-years. Located in Augusta, GA our 84-bed facility provides a therapeutic setting for those seeking treatment for mental illness. Lighthouse Care Center offers unique and individualized programming for adolescents and adults that sets us apart from many other treatment facilities, and our tenured team includes seasoned medical staff.

Responsibilities

Lighthouse Care Center of Augusta has been providing psychiatric services for more than 15-years. Located in Augusta, GA our 84-bed facility provides a therapeutic setting for those seeking treatment for mental illness. Lighthouse Care Center offers unique and individualized programming for adolescents and adults that sets us apart from many other treatment facilities, and our tenured team includes seasoned medical staff.

Website: https://www.LighthouseCareCenters.com

The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care; ensuring that delivery of high-quality and cost-effective treatment is consistent with the mission, vision, and values of Universal Health Services and in accordance with government regulation, licensing and accreditation requirements. Under the direction of the UR Manager, the Utilization Review Coordinator is responsible for conducting clinical review of data to determine eligibility respective to pre-certification and continued stay reviews.

Job Duties/ Responsibilities

• Review clinical content of medical records, participate in treatment team meetings, and collaborate with physicians, therapist, nurses and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved.
• Ensure input of pre-certifications and continued stay reviews into Midas, follow-up on unfinished pre-certifications from the day before, coordinate with the treatment team on any follow-ups necessary, verify insurance coverage at the first of the month, and post patient payments into MS4.
• Trained in all aspects relative to timely gathering of clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer based systems, in addition to other job duties.

Benefit Highlights

• Referral Bonus Program
• 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
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Qualifications

EDUCATION AND EXPERIENCE

Masters level education in social science field (social work, counseling, sociology, psychology).

Must be license-eligible or licensed in Georgia. (LAPC, LPC, LMSW, LCSW, LMFT, LMHC)

Nurses with a current GA or Multistate license encouraged to apply. (LPN, RN)

Must have 2 years of experience in a psychiatric health care setting, delivery of care to psychiatric and/or chemically dependent patients and utilization review.

CERTIFICATIONS, LICENSES, REGISTRATION

LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN or RN preferred.