UTILIZATION REVIEW (UR) SPECIALIST

Universal Health Services; North Stonington (CT); On-site; USD 50,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Utilization Review Specialist to manage pre-certification, concurrent, and discharge reviews for clients. This role is vital in ensuring that individuals receive the appropriate level of care in a supportive environment. With a commitment to quality substance abuse treatment, the position offers opportunities for professional growth and development. Join a team that values compassion and collaboration, where your expertise will directly impact the lives of individuals seeking help. This is your chance to thrive in a rewarding career while making a meaningful difference in the community.

Benefits

Comprehensive medical benefits

Dental and vision insurance

401K

Tuition reimbursement

Career growth opportunities

Challenging work environment

Qualifications

• Knowledge of UR processes, insurance, mental health, and chemical dependency treatment is essential.
• Masters Degree preferred; Bachelors in Psychology or related Human Service Field or RN required.

Responsibilities

• Manage pre-certification, concurrent, and discharge reviews for clients.
• Consult with Admissions regarding LOC issues and insurance requests.
• Coordinate with colleagues and payors on client care transitions.

Skills

Utilization Review Processes

Insurance Knowledge

Clinical Coordination

Communication Skills

Computer Skills

Education

Masters Degree

Bachelors in Psychology

RN

Tools

UR Tracking System (Midas)

Job description

Responsibilities

Are you caring, compassionate, and hardworking? Our facility provides a place for you to thrive and continue your professional development.

Stonington Institute, a division of Universal Health Services (UHS), offers immediate full-time employment for a UR Specialist.

We are committed to quality substance abuse treatment for adults in Southeastern Connecticut, including medical detox, residential, partial hospitalization, and outpatient programs. Our facilities feature amenities like overnight accommodations, meals, recreation, and more, accepting various insurance plans.

About Universal Health Services

UHS is a leading provider of hospital and healthcare services, recognized as one of the World's Most Admired Companies by Fortune and listed in Forbes. We operate hospitals, behavioral health facilities, outpatient centers, and more across the U.S., Puerto Rico, and the UK. www.uhs.com

Job Summary

The Utilization Review Specialist manages pre-certification, concurrent, and discharge reviews for clients at all care levels, ensuring approval for admissions and ongoing treatment.

Job Duties and Responsibilities

1. Consult with Admissions regarding LOC issues, insurance requests, and criteria questions.
2. Complete initial precertification for all care levels.
3. Maintain knowledge of UR processes for all payor sources, including precertification, reviews, and discharge.
4. Conduct concurrent reviews on assigned cases.
5. Identify and advocate for appropriate care levels based on clinical information.
6. Coordinate with colleagues and payors on client care transitions.
7. Collaborate with clinicians to obtain clinical and discharge information.
8. Learn and utilize the UR Tracking System, Midas, for timely data entry.
9. Monitor UR reports daily.
10. Accurately document and file all authorization information.
11. Address insurance changes promptly and communicate with relevant departments.
12. Ensure daily communication of authorization info to Billing.
13. Notify UR Department Head and Billing of denials; complete appeals as needed.
14. Act as liaison between insurance and clinical staff regarding approvals.
15. Participate in monthly UR meetings.

Employee Benefits

• Challenging and rewarding work environment
• Career growth opportunities
• Comprehensive benefits including medical, dental, vision, 401K, tuition reimbursement, and more

Apply today to join our team!

EEO Statement

UHS is committed to a respectful, inclusive environment and provides equal employment opportunities regardless of race, religion, gender, age, sexual orientation, disability, veteran status, or other protected characteristics.

Notice

Our HR team is dedicated to matching candidates with suitable career paths. Beware of scams; no legitimate recruiter will ask for personal or financial info via email. Report suspicious activity at https://uhs.alertline.com or call 1-800-852-3449.

Qualifications

Masters Degree preferred; Bachelors in Psychology or related Human Service Field or RN required. Knowledge of UR processes, insurance, mental health, and chemical dependency treatment is essential. Computer skills are preferred.