Utilization Management Case Manager- Full Time Day Shift, 8:30 a.m. to 5:00 p.m.
Universal Health Services, Inc.
May 1, 2018
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. In 2017, UHS was 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.
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.
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 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.
Havenwyck Hospital provides a continuum of individualized treatment to children, adolescents and adults needing psychiatric and/or substance abuse treatment. Havenwyck strives to create a customized treatment plan for each individual based on level of maturity, life experiences, needs and other factors. Patients at Havenwyck are treated by a qualified multi-disciplinary team, including, but not limited to, a psychiatrist, registered nurses, social workers and recreational therapists, in a warm, supportive environment. Havenwyck Hospital's Residential Treatment Center is a secure treatment program for children and adolescents ages 8 to 17, with emotional and/or behavioral impairments that require them to be in a secure, 24-hour supervised therapeutic living situation. For more information, please visit our website at havenwyckhospital.com.
Havenwyck Hospital is seeking a dynamic and talented Utilization Management Case Manager to join our team of compassionate, dedicated 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 to minimize denials/facilitate optimal use of hospital resources.
Key responsibilities include:
Using Clinical judgment, acts as a liaison between the hospital care team and to external entities an accurate presentation of the medical management of a patient's illness, length of stay and care alternatives available within the confines on the client's benefits and financial resources. Relays clinical data in a professional, assertive, clear and organized manner.
Communicates with the Treatment Team (physicians, nursing staff, social workers, etc.) as necessary to advocate for the patient's clinical treatment within the confines on the client's benefits and financial resources.
Maintains a positive and professional rapport with managed care providers; acts as a representative of Havenwyck Hospital.
Communicates accurate results of reviews with the Treatment Team. Communicates specific criteria and any special requirements of external payers regarding treatment planning.
Refers cases to the Physician Advisor/designee.
Informs physician of need to contact the managed care reviewers and follows up to ensure call is made and ascertain the number of days obtained.
Maintains in data systems an accurate record of days certified for patients.
Has a working knowledge of insurance verification and benefits.