Utilization & Review Clinician (MSW)

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

Benefits offered by this job

Competitive pay

Medical, dental, vision, prescription

401(k) with company match

Education assistance

Career development

Job summary

Heritage Oaks Hospital is part of the UHS family and located in northern Sacramento. The Utilization Review Clinician will manage and monitor patient resource utilization, acting as a liaison between payors, the business office, and the treatment team to ensure appropriate and efficient care and reimbursement.

Requirements include an MSW degree, and either one year of external review communications or four years of clinical psychiatric experience, plus prior authorizations or case management

Qualifications

• Master's degree in social work, mental health or a related field.
• A minimum of one year experience with communication with external review organizations or four years direct clinical experience in a psychiatric or mental health setting.
• Prior experience with prior authorizations or Case Management is preferred.
• Licensure: MSW degree
• Additional Requirements: Trained in Handle with Care (HWC) within 30 days; CPR certification required.

Responsibilities

• Manages, reviews and monitors utilization of resources related to the patient to maximize effectiveness of care.
• Acts as liaison between payors, the business office, and treatment team to assist in care and reimbursement.
• Reviews with payor sources and receives authorization for services through all levels of care and aftercare.
• Attends treatment planning meetings and coordinates care considering available financial resources.

Education

Master's degree in social work, mental health or a related field

Job description

Responsibilities

Heritage Oaks Hospitalis part of the UHS Family of Providers which has been highly regarded as an integral part of the greater Sacramento and Northern California mental health system since 1988. Conveniently located in northern Sacramento, Heritage Oaks is a fully accredited, 125-bed acute psychiatric hospital offering a full range of individually tailored treatment services to adolescents, adults, and senior adults, including treatment for substance abuse and chemical dependency issues with drugs and alcohol. Heritage Oaks is a Medicare provider in addition to contracts with most commercial health insurance plans. Heritage Oaks has three outpatient centers as part of the Branches Outpatient of the greater Sacramento. Providing partial hospitalization programs (PHP) and intensive outpatient programs (IOP) to support patients on their road to wellness. We are committed to providing service excellence to all and ensuring our patients receive the optimal level of care that will be most beneficial to their health and recovery.

Website: https://heritageoakshospital.com/

The Utilization Review Clinician is responsible for the managing, reviewing and monitoring the utilization of resources related to the patient and to maximize effectiveness of care by evaluating clinical appropriateness. The Utilization Review Clinician functions as liaison between payors, the business office, and treatment team, providing information and feedback to assist in optimum patient care and reimbursement. The UR Clinician will also review with payor sources and receive authorization for the type and volume of services through all levels of care and aftercare review.

• Works cooperatively with Assessment & Referral in establishing clinical pre-authorization.
• Communicates with the business office regarding any information pertaining to insurance benefits and coverage.
• Attend treatment planning meetings and oversee the coordination of care for patients in respect to the available financial resources which includes notifying attending physician/treatment team of actual or potential denial.

Heritage Oaks offers comprehensive benefits such as:

• Competitive Compensation
• Excellent Medical, Dental, Vision, and Prescription Drug Plan
• Generous Paid Time Off
• 401(K) with company match and discounted stock plan
• Career development opportunities within UHS and its Subsidiaries
• Education Assistance
• Challenging and rewarding work environment

Qualifications

Education: Master's degree in social work, mental health or a related field.

Experience:

A minimum of one (1) year experience with communication with external review organizations or comparable entities or four (4) years direct clinical experience in a psychiatric or mental health setting.

Prior experience with prior authorizations or Case Management is preferred.

Licensure: MSW degree

Additional Requirements: Trained in Handle with Care (HWC) within the first 30 days of employment. Training provided by HOH. CPR certification required.

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues exceeding $11 billion in 2019. In 2020, UHS was again recognized as one of the World's Most Admired Companies by Fortune on the Fortune 500; and recognized in Forbes ranking of America's Top 500 Public Companies. Headquartered in King of Prussia, PA, UHS has over90,000 employees and through its subsidiaries operates 26 acute care hospitals, 328 behavioral health facilities, 42 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 37 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.

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. We believe that diversity and inclusion among our teammates is critical to our success.