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Universal Health Services

Manages hospitals and behavioral health facilities

Utilization Review Coordinator

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Part-timeRaleigh, NC, USANo salary listedIn-person

About the Job

Requirements

  • A bachelor's degree in Nursing, Counseling, Psychology, or Social Work is required; a master's degree is preferred.
  • One year of experience in Utilization Management in a hospital setting is required.
  • Knowledge of behavioral managed care and clinical assessment skills to align patient acuity with level-of-care practice guidelines is required.
  • RN licensure or a master's degree in a Behavioral Health field, such as Counseling, Psychology, or Social Work, is required.
  • Skills in applying DSM methodology are required.
  • Intermediate computer skills are required.
  • Understanding of appropriate clinical assessment, diagnoses, and interventions with patients is required.
  • Understanding of admission and discharge criteria and functions is required.
  • Understanding of medical terminology, diagnostic terms, treatment modalities, and medical record keeping is required.
  • Understanding of psychiatric evaluations, medical consultations, laboratory results, medication management, and other components of patient treatment is required.
  • Effective oral and written communication skills and the ability to analyze and evaluate information are required.
  • Ability to concentrate on tasks and meet deadlines is required.
  • Organizational, time-management, problem-solving, and crisis-management skills, flexibility, creativity, and the ability to manage stress are required.
  • Ability to interact effectively with people in diverse roles, backgrounds, cultures, and socioeconomic classes is required.
  • Effective telephone etiquette, tact, audible speech, and good enunciation are required.

Responsibilities

  • Coordinate and monitor appropriate utilization and documentation of services throughout patients’ inpatient and outpatient treatment, and coordinate authorization with third-party payors.
  • Review cases for appropriateness of admission, continued stay, and discharge planning.
  • Promote and maintain high-quality patient care by analyzing, reviewing, and evaluating clinical practices within the hospital.
  • Maintain communication about treatment through documentation and verbal exchange.
  • Communicate with internal and external entities to facilitate acquisition of resources.
  • Conduct concurrent and extended-stay reviews on the appropriate day or at the specified time.
  • Prepare and submit appeals to third-party payors, coordinating collection of pertinent data to support the hospital’s and patient’s position.
  • Call or fax discharge information to insurance companies within 24 hours of discharge to ensure payment for the hospital stay.
  • Maintain and update review logs and other appropriate Utilization Review department records.
  • Communicate pertinent third-party payor issues to the doctor and treatment team.
  • Attend daily treatment-team meetings to discuss acuity issues and third-party payor needs, and gather information for reviews.
  • Independently gather information for reviews from patient records and seek information from treatment-team members.
  • Explain insurance information, including benefits and available levels of care, to team members.
  • Perform internal utilization reviews as indicated.
  • Identify, document, and report all instances of adult or child abuse and neglect to appropriate parties, including management, police, and state agencies.

Desired Qualifications

  • Experience in an inpatient psychiatric setting as a counselor and/or nurse is preferred.

About the Company

Universal Health Services

Manages hospitals and behavioral health facilities

Universal Health Services operates a network of acute care hospitals, behavioral health facilities, and ambulatory centers across the United States. It generates its services by acquiring and managing healthcare facilities, then integrating them under centralized operating practices to deliver patient care. The company’s offering is the management and provision of hospital and behavioral health services, with a focus on standardized clinical operations, economies of scale, and nationwide coverage. What sets UHS apart is its long history of growth through acquisitions, its size and scale in both acute and behavioral health markets, and its ability to integrate new facilities while maintaining consistent care quality. Its goal is to provide high-quality healthcare across a broad network, improve patient outcomes, and sustain long-term value for shareholders by expanding access and efficiency in hospital and behavioral health services.

Company size
10,001+
Company stage
IPO
Headquarters
Upper Merion Township, Pennsylvania
Founded
1978

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