Utilization Review (UR) Coordinator PRN

UHS•West Allis, WI

About The Position

Granite Hills Hospital offers high-quality, patient centered behavioral health care for the greater Milwaukee community. Our 120-bed facility will feature evidence-based treatment for adolescents, adults, and older adults. We are looking for looking for a PRN Utilization Review (UR) Coordinator to join our new team. The UR Coordinator has responsibility for organizing and conducting the managed care process. The 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 accross departments to minimize denials/facilitate optimal use of hospital resources. Granite Hills Hospital offers comprehensive benefits such as: Competitive Compensation Excellent Medical, Dental, Vision, and Prescription Drug Plan Generous Paid Time Off 401(K) with company match and discounted stock plan Career development opportunities within UHS and its Subsidiaries Education Assistance Challenging and rewarding work environment Interested applicants may apply directly through our website https://granitehillshospital.com/ and apply through the Careers tab. One of the nation’s 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. UHS is recognized as one of the World’s Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America’s Top 500 Public Companies.

Requirements

Bachelor degree in social work, psychology, or counseling.
Master’s degree in social work, psychology, or counseling preferred.
LPN/LVN required.
ADN, BSN preferred.
Limited or full licensure is preferred.
Experience in psychiatric or substance abuse treatment preferred.
Hospital utilization review/utilization management experience required.
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.
Must possess a valid Driver’s License

Nice To Haves

Prefer knowledge of the Milwaukee behavioral health marketplace, insurance plans, target markets and referral sources, psychiatric and chemical dependency treatment and, age-specific programming.

Responsibilities

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
acting as liaison with MD/Clinical Treatment Team and external agencies
Report authorizations, denials, and documentation concerns, as well as collaborate effectively accross departments to minimize denials/facilitate optimal use of hospital resources.