UTILIZATION REVIEW COORDINATOR

Henderson Hospital; Raleigh (NC); In loco; USD 65.000 - 90.000; Tempo pieno

Vantaggi offerti da questo lavoro

Loan Forgiveness Program

Tuition Reimbursement

401(k) with company match

Career development opportunities

Descrizione del lavoro

Universal Health Services, Inc. seeks a Utilization Management professional to coordinate and monitor patient care across inpatient and outpatient programs. You will work to ensure appropriate utilization and timely authorizations with payors, while collaborating with the treatment team to optimize patient outcomes.

The role requires clinical assessment knowledge, documentation discipline, and strong communication skills to support admission decisions and discharge planning in a hospital setting.

Competenze

• Bachelor degree in Nursing, Counseling, Psychology or Social Work; Masters degree preferred.
• RN Licensure or Master’s degree in Behavioral Health.
• Experience in Utilization Management in a hospital setting is preferred.

Mansioni

• Coordinate and monitor utilization and documentation for inpatients and outpatients.
• Coordinate authorization with third‑party payors.
• Review admissions, continued stays, and discharge planning for appropriateness.
• Attend daily treatment team meetings to discuss acuity and payor needs.
• Submit appeals to third‑party payors with supporting data.
• Communicate insurance information to team members and update records.

Conoscenze

DSM methodology

Telephone etiquette

Interpersonal skills

Written communication

Time management

Crisis management

Medical terminology

Formazione

Bachelor degree in Nursing, Counseling, Psychology or Social Work

RN Licensure or Master’s degree in Behavioral Health

Masters degree preferred

Descrizione del lavoro

Responsibilities

Job Description

Responsibilities

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, our annual revenues were $11.4 billion in 2019. In 2020, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; in 2019, ranked #293 on the Fortune 500; and in 2017, listed #275 in Forbes inaugural ranking of America’s Top 500 Public Companies. Headquartered in King of Prussia, PA, UHS has more than 90,000 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.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.

Qualifications

QUALIFICATIONS:

Education/Training:

• Bachelor degree in one of the following majors: Nursing, Counseling, Psychology or Social Work). Masters degree preferred.
• One (1) year experience in Utilization Management in a hospital setting
• Knowledge in behavioral managed care and clinical assessment skills to align patient acuity with level of care practice guidelines

Experience:

• Experience in an inpatient psychiatric setting as a counselor and/or nurse is preferred.

Licensure/Certification:

• RN Licensure or Master’s degree in Behavioral Health field (e.g. Counseling, Psychology, or Social Work)

Schedule:

• Monday to Friday (PRN)

POSITION SUMMARY:

• Coordinate and monitor appropriate utilization and documentation of services throughout the course of treatment for patients admitted to the inpatient and outpatient programs and coordinate authorization with third-party payors.
• Review cases for appropriateness of admission, continued stay, and discharge planning.
• Assist in the promotion and maintenance of high quality patient care through the analysis, review and evaluation of clinical practices within the Hospital.
• Maintain communication system based on documentation and verbal exchange regarding treatment.
• Communicate with internal and external entities to facilitate acquisition of resources.

Responsibilities will include:

• Conduct concurrent and extended stay reviews on appropriate day and/or specified time.
• Prepare and submit appeals to third party payors, effectively coordinating collection of all pertinent data to support the hospital and patient’s position.
• Call/fax discharge information to insurance companies within 24 hours of discharge to ensure the facility is paid for the hospital stay.
• Maintain and update logs of review and maintain other appropriate records of the Utilization Review department.
• Communicate pertinent third party payors issues to doctor and treatment team.
• Attend daily treatment team meetings to discuss acuity issues, third party payors needs and gather information for reviews.
• Work independently in gathering information for reviews from the patient record, taking the initiative to seek information from members of the treatment team.
• Understand and communicate insurance information to team members, including benefits and levels of care offered.
• Perform internal utilization reviews as indicated.
• Identify, document, and report any and all instances of adult or child abuse and neglect to the appropriate parties including a member of management, the police, and state agencies

Knowledge and Skills:

• Skills in application of DSM methodology.
• Excellent telephone etiquette, tact, and audible speech, with good enunciation.
• Ability to interact effectively with persons of widely diverse roles, backgrounds, cultures, and socio- economic classes.
• Effective oral and written communication skills and skills in analyzing and evaluating information.
• Ability to concentrate on tasks and meet deadlines.
• Intermediate computer skills.
• Organizational, time management, problem solving, crisis management skills as well as flexibility, creativity, and the ability to manage stress.
• Understand appropriate clinical assessment, diagnoses, & interventions with patients.
• Understand admission and discharge criteria and function.
• Understand medical terminology, diagnostic terms, treatment modalities, and medical record keeping.
• Understand psychiatric evaluations, medical consultations, lab results, medication management, and other components of patient treatment.

Benefit Highlights:

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• Loan Forgiveness Program
• Tuition Reimbursement
• 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: benefits.uhsguest.com

Qualifications

QUALIFICATIONS:

Education/Training:

• Bachelor degree in one of the following majors: Nursing, Counseling, Psychology or Social Work). Masters degree preferred.
• One (1) year experience in Utilization Management in a hospital setting
• Knowledge in behavioral managed care and clinical assessment skills to align patient acuity with level of care practice guidelines

Experience:

• Experience in an inpatient psychiatric setting as a counselor and/or nurse is preferred.

Licensure/Certification:

• RN Licensure or Master’s degree in Behavioral Health field (e.g. Counseling, Psychology, or Social Work)

Schedule:

• Monday to Friday (PRN)

POSITION SUMMARY:

• Coordinate and monitor appropriate utilization and documentation of services throughout the course of treatment for patients admitted to the inpatient and outpatient programs and coordinate authorization with third-party payors.
• Review cases for appropriateness of admission, continued stay, and discharge planning.
• Assist in the promotion and maintenance of high quality patient care through the analysis, review and evaluation of clinical practices within the Hospital.
• Maintain communication system based on documentation and verbal exchange regarding treatment.
• Communicate with internal and external entities to facilitate acquisition of resources.

Responsibilities will include:

• Conduct concurrent and extended stay reviews on appropriate day and/or specified time.
• Prepare and submit appeals to third party payors, effectively coordinating collection of all pertinent data to support the hospital and patient’s position.
• Call/fax discharge information to insurance companies within 24 hours of discharge to ensure the facility is paid for the hospital stay.
• Maintain and update logs of review and maintain other appropriate records of the Utilization Review department.
• Communicate pertinent third party payors issues to doctor and treatment team.
• Attend daily treatment team meetings to discuss acuity issues, third party payors needs and gather information for reviews.
• Work independently in gathering information for reviews from the patient record, taking the initiative to seek information from members of the treatment team.
• Understand and communicate insurance information to team members, including benefits and levels of care offered.
• Perform internal utilization reviews as indicated.
• Identify, document, and report any and all instances of adult or child abuse and neglect to the appropriate parties including a member of management, the police, and state agencies

Knowledge and Skills:

• Skills in application of DSM methodology.
• Excellent telephone etiquette, tact, and audible speech, with good enunciation.
• Ability to interact effectively with persons of widely diverse roles, backgrounds, cultures, and socio- economic classes.
• Effective oral and written communication skills and skills in analyzing and evaluating information.
• Ability to concentrate on tasks and meet deadlines.
• Intermediate computer skills.
• Organizational, time management, problem solving, crisis management skills as well as flexibility, creativity, and the ability to manage stress.
• Understand appropriate clinical assessment, diagnoses, & interventions with patients.
• Understand admission and discharge criteria and function.
• Understand medical terminology, diagnostic terms, treatment modalities, and medical record keeping.
• Understand psychiatric evaluations, medical consultations, lab results, medication management, and other components of patient treatment.

Benefit Highlights:

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• Loan Forgiveness Program
• Tuition Reimbursement
• 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: benefits.uhsguest.com

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.