1+ months

Utilization Management Case Manager PRN Contingent - (102516)

Universal Health Services
Auburn Hills, MI 48326
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One of the nations largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. In 2017, UHS was recognized as one of the Worlds Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of Americas Top 500 Public Companies.

Our operating philosophy is as effective today as it was 40 years ago: Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve.

Headquartered in King of Prussia, PA, UHS has more than 81,000 employees and through its subsidiaries operates more than 320 acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom.

What do our current Employees value at UHS?

An environment that puts patient care first. One of the most rewarding aspects of working as an employee here is providing excellent care, comfort, and security to patients and families you treat, at their most vulnerable times. Having the opportunity to grow, learn, and advance in your career. There are very robust continuing education options and opportunities for leadership development as an employee with UHS. Supportive and responsive leadership. Competitive salary and comprehensive benefits package.

Havenwyck Hospital is a 243 bed, Joint Commission accredited and licensed psychiatric and substance abuse facility. We specializing in providing behavioral health and substance abuse treatment and are located in Auburn Hills overlooking Lake Galloway. For more information, please visit our website at havenwyckhospital.com.

Mission Statement: To provide individualized, quality behavioral health care, in a safe and secure environment where dignity and respect are upheld by our team of dedicated, caring, professional staff, in a cost-effective manner.

Havenwyck Hospital is seeking a dynamic and talented licensed Utilization Management Case Manager to join our team of compassionate and dedicated clinical professionals.

The Utilization Management Case Manager has responsibility for organizing and conducting the managed care process. These duties shall be directed toward supporting the hospital's mission in the pursuit of excellence in care/service and will include (but not limited to): conducting timely admission and continued stay record reviews with external payers, utilizing approved criteria to make determinations of medical necessity and level of care planning, verifying active treatment by completing internal audit reviews within approved time frames, assisting the treatment team when indicated in the discharge planning process, and acting as liaison with MD/Clinical Treatment Team and external agencies. Report authorizations, denials, and documentation concerns, as well as collaborate effectively across departments. Report authorizations, denials, and documentation concerns, as well as collaborate effectively across departments to minimize denials/faciliate optimal use of hospital resources.

This includes, but is not limited to the following duties:

  • Through clinical skills (experience and knowledge), reports to external insurance and review entities an accurate presentation of the medical management of a patients illness, length of stay and care alternatives available within the confines on the clients benefits and financial resources.
  • Communicates with the Treatment Team (physicians, nursing staff, social workers, etc.) as necessary to advocate for the patients clinical treatment within the confines on the clients benefits and financial resources
  • Using clinical skills (experience and knowledge) assists the team in ensuring the completeness and accuracy of the medical record.
  • Communicates results of reviews with physicians and team via direct contact, phone calls and chart stickers. Communicates specific criteria and special requirement of managed care regarding discharge planning, family sessions, and treatment plans.
  • Monitors and tracks the certification and re-certification process for Medicare patients to make certain all state and federal reporting guidelines are met.
  • Ensures accurate documentation of authorization status and provides appropriate information to the hospital fiscal department to assist in the timely filing of claims, which, in turn, facilitates the accurate and appropriate reimbursement for services rendered.
  • Reviews cases on a daily basis, checking for discharges and day hospital admission and relaying pertinent information
  • Has a working knowledge of insurance verification and benefits.
  • Possess clinical skills including specific knowledge of diagnosis and dynamics involved in the treatment of psychiatric illnesses for patients of all ages.
Job Requirements
  • Masters degree in social work, psychology, or counseling; or a Bachelors degree in nursing.
  • Valid and unrestricted license (RN, LMSW, LLP, LPC, etc.). A minimum of 2 years of post-graduate related experience in psychiatric or substance abuse treatment.
  • Experience in settings that include inpatient or partial hospitalization preferred.
  • Familiarity with managed health care process, medical terminology, experience in case management, discharge planning, and/or utilization review preferred.
  • Employee must be in good standing (employment/corrective action history, performance evaluation, etc.) to be considered for an internal transfer.

This opportunity provides the following:

  • Meaningful work, saving patient lives
  • Healthy, respectful and team-based work environment
  • Growth and development opportunities within UHS and its subsidiaries
  • Competitive Compensation
  • Student Loan Refinancing Program

UHS is a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc. and a wholly-owned subsidiary of Universal Health Services, Inc. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its management company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiaries of Universal Health Services, Inc. To the extent any reference to UHS or UHS facilities on this website including any statements, articles or other publications contained herein relates to our healthcare or management operations it is referring to Universal Health Services subsidiaries including UHS of Delaware. Further, the terms we, us, our or the company in such context similarly refer to the operations of Universal Health Services subsidiaries including UHS of Delaware. Any employment referenced in this website is not with Universal Health Services, Inc. but solely with one of its subsidiaries including but not limited to UHS of Delaware, Inc.

UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via- email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.

Posted: 2019-11-07 Expires: 2020-04-02

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Utilization Management Case Manager PRN Contingent - (102516)

Universal Health Services
Auburn Hills, MI 48326

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