Utilization Review/Management Coordinator
Universal Health Services, Inc., Grand Rapids, MI, United States
Responsibilities
Benefit Highlights:
Challenging and rewarding work environment
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plan
401(K) with company match and discounted stock plan
Career development opportunities within UHS and its 300+ Subsidiaries
Shift differentials are paid for evening,nightand weekend shifts
Position Summary
The Utilization Review Coordinator is dedicated togatherand coordinating informationregardingpatient symptomatology and treatment modalities for the purpose of internal and concurrent reviews with insurance companies.
Essential Job Functions and Responsibilities
1. Negotiates and advocates on behalf of the patient and the Hospital.
2. Assesses and interprets mostappropriate levelof care based upon patient present level of functioning and responsiveness to treatment interventions. Provides clinical appropriateness data (verbal and written) to outsideutilizationreview agencies and insurance companies according to policy and procedure.
3.Reviewdischarges, as assigned.Calculate length of stay and document number of days certified for billing purposes.Report discharges to outside reviews asindicated, including discharge plan and medications.
4. Complete continued stay reviews with external review agencies asindicated.
5. Complete pre-certifications, as assigned.
6. Prioritizes daily workload betweenvarious typesof reviews and discharges to ensuretimelycompletion.
7.Assistwith denial/appeals, including maintenance of deniallogfor assigned cases.
8.ProvideUtilization Review guidance consultative services to UR department and to all departments when requested. Services include analysis of medical records,dataand participation in committees as requested.
9. Analyzes patient clinical information to determine patient length of stay and level of care.
10. Review all assigned Medicare charts for medical necessity and report findings totreatmentteam weekly.
11. Maintains Utilization Review files and logs in a neat,accurateand orderly form.
12. Provides feedback to the Department Manager on the development/modification of theutilizationreview plan.
13. Attends treatment team daily to review assigned cases with team.
14. Complete andupdatesMIDAS reports daily, as assigned.
15. Assume Hospital Safety Responsibilities.
Qualifications
Minimum Skills, Experience, Licensure and Educational Requirements
1. RN/MA/MSW.
2. Professional licensure in the State of Michigan.
2. Experience working with psychiatricutilizationreview criteria.
3. Knowledge of psychiatric program delivery andutilizationreview criteria.
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 itsinceptioninto a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has99,000 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., PuertoRicoand 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.
Avoid and Report Recruitment Scams
We are aware of ascamwhereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillsetand experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, creditcardor bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns toappropriate lawenforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.
Benefit Highlights:
Challenging and rewarding work environment
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plan
401(K) with company match and discounted stock plan
Career development opportunities within UHS and its 300+ Subsidiaries
Shift differentials are paid for evening,nightand weekend shifts
Position Summary
The Utilization Review Coordinator is dedicated togatherand coordinating informationregardingpatient symptomatology and treatment modalities for the purpose of internal and concurrent reviews with insurance companies.
Essential Job Functions and Responsibilities
1. Negotiates and advocates on behalf of the patient and the Hospital.
2. Assesses and interprets mostappropriate levelof care based upon patient present level of functioning and responsiveness to treatment interventions. Provides clinical appropriateness data (verbal and written) to outsideutilizationreview agencies and insurance companies according to policy and procedure.
3.Reviewdischarges, as assigned.Calculate length of stay and document number of days certified for billing purposes.Report discharges to outside reviews asindicated, including discharge plan and medications.
4. Complete continued stay reviews with external review agencies asindicated.
5. Complete pre-certifications, as assigned.
6. Prioritizes daily workload betweenvarious typesof reviews and discharges to ensuretimelycompletion.
7.Assistwith denial/appeals, including maintenance of deniallogfor assigned cases.
8.ProvideUtilization Review guidance consultative services to UR department and to all departments when requested. Services include analysis of medical records,dataand participation in committees as requested.
9. Analyzes patient clinical information to determine patient length of stay and level of care.
10. Review all assigned Medicare charts for medical necessity and report findings totreatmentteam weekly.
11. Maintains Utilization Review files and logs in a neat,accurateand orderly form.
12. Provides feedback to the Department Manager on the development/modification of theutilizationreview plan.
13. Attends treatment team daily to review assigned cases with team.
14. Complete andupdatesMIDAS reports daily, as assigned.
15. Assume Hospital Safety Responsibilities.
Qualifications
Minimum Skills, Experience, Licensure and Educational Requirements
1. RN/MA/MSW.
2. Professional licensure in the State of Michigan.
2. Experience working with psychiatricutilizationreview criteria.
3. Knowledge of psychiatric program delivery andutilizationreview criteria.
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 itsinceptioninto a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has99,000 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., PuertoRicoand 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.
Avoid and Report Recruitment Scams
We are aware of ascamwhereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillsetand experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, creditcardor bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns toappropriate lawenforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.