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PRN Utilization Management Coordinator

Quick overview

The Utilization Management Coordinator will proactively monitor the utilization of continuum services and work to optimize reimbursement for the hospital. Key duties involve conducting admission, concurrent, and extended stay reviews, preparing appeals for third-party payors, and ensuring timely discharge information is communicated.

Requirements summary

Minimum Qualifications

require an MSW or MS in a recognized mental health field or a Registered Nursing License, along with one year of experience in case management and/or hospital settings. Preferred experience includes one year as a Utilization Management Coordinator in a long-term care facility.

professional certificatepostgraduate degreeRecord MaintenanceInformation GatheringReimbursement OptimizationAppeal PreparationAbuse ReportingConcurrent ReviewsUtilization MonitoringInsurance CommunicationAdmission ReviewsThird Party Payor CoordinationDischarge ReportingExtended Stay ReviewsAcuity DiscussionInternal Utilization Reviews

Job description

Responsibilities

Dover Behavioral Health System is a 104-bed, acute care psychiatric hospital located in the beautiful Dover, Delaware area.
Dover Behavioral Health System features individual units for adolescents and adults and offers inpatient acute care, partial hospitalization, and intensive outpatient programs.
On average, over 10,000 patients receive care from our compassionate health care team each year at Dover Behavioral Health System.
This opportunity offers working at a hospital known for its outstanding patient satisfaction, including ranking 6th for highest patient satisfaction in 2020 compared to over 200+ psychiatric hospitals.
We attribute this success to our talented and dedicated staff.
We are the best at what we do!
Dover Behavioral Health system is seeking qualified candidates for our Per Diem Utilization Management Coordinator position.
In this role, you will proactively monitor utilization of continuum services and optimize reimbursement.
Responsibilities will include: Conduct admission reviews working with Assessment and Referral Services to stay abreast of admissions.
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.

MSW or MS in a recognized mental health field or a Registered Nursing License One (1) year experience in case management and/or hospital experience
Preferred: One (1) year experience as a Utilization Management Coordinator at a long-term care facility
About our parent company
Universal
Health
Services (UHS): 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 $10.77 billion in 2018. 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 87,000 employees and through its subsidiaries operates 26 acute care hospitals, 327 behavioral health facilities, 40 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 subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience with the best possible career 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 feel suspicious of a job posting or job-related email, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449

PRN Utilization Management Coordinator

Quick overview

Requirements summary

Minimum Qualifications

Job description

Responsibilities

Qualifications

Minimum

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