UTILIZATION REVIEW COORDINATOR

UHS-posted 3 months ago
Mid Level
Orlando, FL
1,001-5,000 employees
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University Behavioral Center, a subsidiary of Universal Health Services, Inc. (UHS), is committed to providing intensive mental health services to children, adolescents and adults as well as detox and substance abuse programs for adults. Our mental health facility provides safe and effective inpatient treatment to assist individuals in leading more productive and fulfilling lives. The facility is located on a beautiful 14-acre campus in Orlando, Florida, and includes 112 licensed beds. Position Summary: Facilitates a continuum of service while promoting positive outcome and optimal reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting. This is a Day Shift position (5 days a week/8 hour shift).

  • Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on payer’s criteria.
  • Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
  • Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
  • Contributes to monthly utilization data trends using hospital data tools to report for the overall operation.
  • Facilitates physician reviews with payers as required.
  • Master’s Degree in Psychology, Mental Health Counseling, Social Work. Bachelor’s Degree in Nursing (Licensed).
  • Three (3) to five (5) years’ experience in chart analysis and utilization review in the psychiatric and chemical dependency field preferred.
  • Skills in application of DSM methodology.
  • Excellent telephone etiquette, tact, and audible speech, with good enunciation.
  • Ability to interact effectively with persons of widely diverse roles, backgrounds, cultures, and socio-economic classes.
  • Effective oral and written communication skills and skills in analyzing and evaluating information.
  • Ability to concentrate on tasks and meet deadlines.
  • Intermediate computer skills.
  • Organizational, time management, problem solving, crisis management skills as well as flexibility, creativity, and the ability to manage stress.
  • Challenging and rewarding work environment
  • Career development opportunities within UHS and its Subsidiaries
  • Competitive Compensation
  • Excellent Medical, Dental, Vision and Prescription Drug Plan
  • 401(K) with company match and discounted stock plan
  • Generous Paid Time Off
  • Free Basic Life Insurance
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