Utilization Coordinator

Responsibilities

FULL TIME - PRN

The Utilization Review Coordinator is responsible for conducting utilization and quality management activities in accordance with Utilization Review policies and procedures. The Coordinator performs the overall function of providing an ongoing, systematic process for the measurement and assessment of the necessity, appropriateness, and efficiency of facility healthcare services and procedures.

This position will directly report to the UR Director and provide upd to date reporting on the departments day to day business for daily meeting updates with Senior Leadership.

Demonstrates Competency in the Following Areas:

• Assisting in the promotion and maintenance of high quality care through the analysis, review, and evaluation of clinical criteria as it relates to patient treatment and length of stay.

• Reviewing cases for appropriateness of admission, continued stay, and discharge planning.

• Managing and effectively utilizing insurance benefits through timely prospective, concurrent, and retrospective review activities.

• Maintain an open communication system with internal and external entities, both through written documentation and verbal exchange regarding patient treatment.

• Communication with internal and external entities to facilitate good customer relations and acquisition of resources.

• Complies with all Administrative, Clinical, and HR policies and procedures.

• Maintains an awareness of patient funding sources, discharge planning needs, and available resources in order to facilitate continuity of care.

• Supervises, plans, and organizes the functions of the facilities Case Management system to minimize denials of payment.

• Manages, prepares, and submits appeals to third party payers on clinical denials.

• Formalizes the UR Program and establishes CQI goals and outcome indicators.

• Reviews payer contracts and regulatory requirements on an on-going basis, updates pertinent policies and procedures, and trains staff on special requirements.

• Attends meetings as scheduled.

• Contributes to UR program goals and objectives in containing health care costs while maintaining a high quality of care.

• Performs prospective, concurrent and retrospective telephonic reviews for inpatient Mental Health and Dual Diagnosis services.

• Collects only pertinent clinical information and documents all UR review information using the HMS software system.

• Promotes alternative care programs and researches available options including costs and appropriateness of patient placement in collaboration with discharge planners and patient.

• Communicates directly with the designated medical director and management staff regarding all inpatient cases and requests for health care services that do not meet medical necessity criteria.

• Maintains an active role in assuring the continuity of care for all inpatients through early discharge planning and working with hospital and health plan patient discharge planners and social worker in the early identification of potential home care candidates or less restrictive level of care placement.

Communicates all UR review outcomes in accordance with the UR policy and procedure.

Qualifications

Regulatory Requirements:

Registered Nurse Preferred

One to three years of experience in utilization review, case management, or discharge planning preferred. Three years of experience in a Behavioral Health facility providing multiple levels of care preferred. Behavioral Health experience. and Masters Degree required. Registered Nurse orlicensed mental health clinician preferred. Strong communication, documentation, clinical and critical thinking skills essential. Working knowledge of utilization management/ case management preferred, strong problem solving and decision making skills essential, strong typing and computer skills essential.

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, annual revenues

exceeding $11 billion in 2019. In 2020, UHS was again recognized as one of the World's Most

Admired Companies by Fortune on the Fortune 500; and recognized in Forbes ranking of

America's Top 500 Public Companies. Headquartered i

n King of Prussia, PA, UHS has over

90,000 employees and through its subsidiaries operates 26 acute care hospitals, 328 behavioral

health facilities, 42 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 our subsidiaries, our Human Resources departments and recruiters are here to

help prospective candidates by matching skillset and experience with the best possible career

path 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 are suspicious of a job posting or job-related email mentioning

UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-