UTILIZATION REVIEW (UR) SPECIALIST - FULL OR PART TIME

Universal Health Services; North Stonington (CT); On-site; USD 60,000 - 76,000; Full time

Benefits offered by this job

Benefits package

Career advancement

401K

Tuition reimbursement

Job summary

Universal Health Services is seeking an Utilization Review Specialist to manage pre-certification, concurrent, and discharge reviews for clients across care levels. The role ensures authorization for admission and continued treatment, coordinating with Admissions, payors, and clinical staff to secure appropriate level of care.

The position requires knowledge of UR processes, insurance plans, and mental health treatment, with strong documentation and computer skills to support timely

Qualifications

• Knowledge of Utilization Review (UR) processes across payor sources (precertification, concurrent reviews, discharge review).
• Knowledge of insurance plans and mental health/chemical dependency treatment.
• Experience or familiarity with UR tracking systems and recordkeeping.
• Computer skills and ability to document accurately in systems.

Responsibilities

• Perform initial precertifications for all levels of care.
• Conduct concurrent reviews on assigned cases.
• Advocate for appropriate level of care based on clinical information.
• Coordinate with admissions, payors, clinicians, and billing on dispositions and changes in care.
• Document and file authorization information accurately and timely.
• Notify UR and Billing of denials and appeals when necessary.
• Participate in monthly UR meetings.

Skills

UR processes knowledge

Insurance plans

Mental health & chemical dependency

Computer skills

Education

Master's degree preferred

Bachelor's degree in Psychology or related Human Service Field or RN

Job description

Responsibilities

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

Job Summary

The Utilization Review Specialist is responsible for the pre-certification, concurrent, and discharge review process for clients at all levels of care, resulting in the approval of their admission and continued treatment.

Job Duties and Responsibilities

• Consult with Admissions Department regarding specific LOC issues, insurance requests, and/or criteria questions.
• Complete initial precertification for all levels of care.
• Knowledge of UR processes required for all payor sources i.e. precertification, concurrent reviews, discharge review.
• Conduct concurrent reviews on assigned cases.
• Ability to identify and advocate for a particular level of care based on the presenting clinical information.
• Coordinate with colleagues and payors regarding client changes in level of care internally or transitions to other internal programs.
• Collaborate with clinicians/case managers to obtain pertinent clinical and discharge information.
• Learn UR Tracking System, Midas; enter daily authorizations and/or other necessary information in a timely manner.
• Print and monitor UR reports on a daily basis.
• Document and file all authorization information accurately and completely.
• Address client insurance changes immediately and communicate results to appropriate departments.
• Ensure that all applicable information is communicated to the Billing Department on a daily basis.
• Notify UR Department Head and Billing of any denials and complete telephonic or written appeals when necessary.
• Liaison between insurance and clinical staff, providing information to clinicians/case managers regarding dispositions that would be approved by insurance.
• Participate in monthly UR Meeting.

Benefits

• Challenging and rewarding work environment
• Career advancement opportunities
• Comprehensive Benefits including Medical, Dental, 401K, Tuition Reimbursement and more (for eligible part-time and full‑time positions)
• Competitive Compensation.

Qualifications

Masters Degree preferred; minimum Bachelors Degree in Psychology or related Human Service Field or RN. Knowledge of Utilization Review Processes, insurance plans, mental health and chemical dependency treatment. Knowledge of various treatment levels of care as well as psychiatric diagnosis. Experience with computer skills preferred.

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.