Utilization & Review Clinician (MSW)
UHS
Summary
The Utilization Review Clinician is responsible for managing, reviewing and monitoring the utilization of resources related to the patient and to maximize effectiveness of care by evaluating clinical appropriateness.
Job description
The Utilization Review Clinician functions as liaison between payors, the business office, and treatment team, providing information and feedback to assist in optimum patient care and reimbursement.
- Review with payor sources and receive authorization for the type and volume of services through all levels of care and aftercare review.
- Works cooperatively with Assessment & Referral in establishing clinical pre-authorization.
- Communicates with the business office regarding any information pertaining to insurance benefits and coverage.
- Attend treatment planning meetings and oversee the coordination of care for patients in respect to the available financial resources which includes notifying attending physician/treatment team of actual or potential denial.
Requirements
- Master's degree in social work, mental health or a related field
- MSW degree
- A minimum of one (1) year experience with communication with external review organizations or comparable entities or four (4) years direct clinical experience in a psychiatric or mental health setting
- Prior experience with prior authorizations or Case Management is preferred
- Trained in Handle with Care (HWC) within the first 30 days of employment
- CPR certification required
Benefits
- Competitive Compensation
- Medical, Dental & Vision
- Prescription Drug Plan
- Paid Time Off
- 401(k) Matching
- Discounted Stock Plan
- Career Development
- Education Assistance
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.