Utilization Review Clinician

Universal Health Services; Westwood (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

Lighthouse Care Center of Augusta, part of Universal Health Services, is seeking an Utilization Review Clinician to join the case management team in Augusta, GA.

The role focuses on reviewing clinical data for pre-certification and continued stay determinations, coordinating with physicians and staff, and ensuring compliant documentation in Midas/MS4.

Qualifications

• Masters level education in social science fields.
• Must be license-eligible or licensed in GA (LAPC, LPC, LMSW, LCSW, LMFT, LMHC).
• Nurses with a GA license encouraged to apply (LPN, RN).
• 2 years of experience in psychiatric health care and utilization review.
• Experience with pre-certification and continued stay reviews.

Responsibilities

• Review medical records and collaborate with the care team to obtain data for insurance communications.
• Input pre-certifications and continued stay reviews into Midas; coordinate follow-ups; verify insurance at month start.
• Input and communicate clinical criteria into computer systems and perform related duties.

Skills

Clinical coordination

Documentation review

Team collaboration

Education

Masters in social sciences

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.

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 Coordinatoris 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.