The Utilization Review Coordinator gathers and coordinates patient information for internal and concurrent reviews with insurance companies, negotiating and advocating on behalf of the patient and hospital. Key duties include assessing the appropriate level of care, reviewing discharges, completing continued stay reviews, and handling pre-certifications to ensure timely completion of daily workloads.
Requirements summary
Candidates must possess an RN, MA, or MSW professional license specifically in the State of Michigan. Required knowledge includes experience working with psychiatric utilization review criteria and understanding psychiatric program delivery.
bachelor degreepostgraduate degreePolicy AdherencePre-certificationsUtilization ReviewPatient CoordinationMedical Necessity ReviewMedical Record AnalysisInsurance NegotiationDenial AppealsLevel Of Care AssessmentContinued Stay ReviewDischarge ReviewClinical Appropriateness DataUtilization Review GuidanceMIDAS ReportsPsychiatric Utilization Review Criteria
Job description
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, night and weekend shifts
Position Summary
The Utilization Review Coordinator is dedicated to gather and coordinating information regarding patient 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 most appropriate level of care based upon patient present level of functioning and responsiveness to treatment interventions. Provides clinical appropriateness data (verbal and written) to outside utilization review agencies and insurance companies according to policy and procedure. 3. Review discharges, as assigned. Calculate length of stay and document number of days certified for billing purposes. Report discharges to outside reviews as indicated, including discharge plan and medications. 4. Complete continued stay reviews with external review agencies as indicated. 5. Complete pre-certifications, as assigned. 6. Prioritizes daily workload between various types of reviews and discharges to ensure timely completion. 7. Assist with denial/appeals, including maintenance of denial log for assigned cases. 8. Provide Utilization Review guidance consultative services to UR department and to all departments when requested. Services include analysis of medical records, data and 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 to treatment team weekly. 11. Maintains Utilization Review files and logs in a neat, accurate and orderly form. 12. Provides feedback to the Department Manager on the development/modification of the utilization review plan. 13. Attends treatment team daily to review assigned cases with team. 14. Complete and updates MIDAS 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.
Benefits
Dental Insurance
Shift Differentials
Vision Insurance
Medical Insurance
Competitive Compensation
Generous Paid Time Off
Prescription Drug Plan
Career Development Opportunities
Discounted Stock Plan
401(K) With Company Match
Experience working with psychiatric utilization review criteria.
3.
Knowledge of psychiatric program delivery and utilization review 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 its inception into a Fortune 500 corporation.
Headquartered in King of Prussia, PA, UHS has 99,000 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., 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.
Avoid and Report Recruitment Scams We are aware of a scam whereby 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 skill set and 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, credit card or 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 to appropriate law enforcement.
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.
