Utilization Review Coordinator

Springwoods Behavioral Health - Fayetteville, AR3.6

30+ days agoFull-time
Springwoods Behavioral Health is an UHS affiliated 80-bed acute care behavioral health facility located in Northwest Arkansas and has been providing quality health care to the residents Northwest Arkansas since 2009. The hospital provides 24-hour acute care behavioral health services.

Springwoods Behavioral Health is seeking a dynamic and talented Utilization Review Coordinator.

Job Description

The Case Manager coordinates the design, development, implementation, and monitoring of Springwoods Behavioral Health’s case management and utilization review functions. The Case Manager will achieve the goals of clinical, financial and utilization as set forth in the UR plan by effective management and communication. The Case Manager functions as the internal resource on issues related to the appropriate utilization of resources, coordination of care across the continuum and utilization review. The Case Manager is responsible for carrying out assignments in a manner to assure success in financial management, quality and operational management objectives. The Case Manager participates in program development and unit performance improvement. The Case Manager consistently demonstrates the core values and mission statement of Springwoods Behavioral Health.

Essential Job Duties:
Completes daily reviews on all patients and oversees the completion of those reviews to all requesting insurance companies per contract agreement.
Receives all denials for care involving patient stays, discusses with medical team feasibility to appeal. Manages all appeals related to denials of patient stays for all payors/insurance companies.
Participates in quality improvement processes and assures implementation of regulatory standards.
Ensures service is provided considering the age-specific physiological, emotional and cognitive needs of the patients served.
Acts as a liaison between the patient/family, physician and patient care team as necessary to problem solve.
Guides staff in the adherence to applicable standards of care/practice and/or departmental/organization expectations.
Establishes, evaluates, and monitors case management processes, policies and procedures to ensure that appropriate Hospital resource utilization is achieved.
Serves as an internal resource and consultant to management, medical staff about case management, reimbursement, clinical resource utilization and care coordination issues.

EDUCATION REQUIREMENTS:
Minimum of 5 years of recent clinical experience preferred
Experience in acute clinical case management and/or utilization review preferred
Experience in related duties in the delivery of patient care, management of patient care providers or project management in a healthcare environment preferred
Current licensure in good standing with the State of Arkansas as a Registered Nurse (RN) or Social Work (LMSW, LCSW, LPC, LAC) required.
Current BLS/AED or the ability to obtain it within 90 days from the date of hire.
CPHM, CCM or ACM preferred

SKILLS, ABILITIES AND COMPETENCIES:
Current knowledge of case management, care coordination and utilization review processes.
Knowledge of or the ability to learn financial management related to UR function and reporting quality and improvement processes.
Ability to effectively monitor, evaluate and administer the resources of each assigned area and make substantial recommendations regarding resource allocation needs for future planning.
Ability to effectively communicate in writing and verbally
Ability to analyze information and problem solve.
Demonstrate evidence of strong skills in confidentiality, integrity, creativity and initiative.
Demonstrates the ability to interact with a wide variety of individuals and handle complex and confidential sensitive situations.
Proficient in the use of computer and multiple software programs.
Ability to perform utilization review, assist and coordinate appeal efforts in a timely fashion.

This opportunity offers the following:
Challenging and rewarding work environment
Growth and Development Opportunities within UHS and its Subsidiaries
Competitive Compensation
Excellent Medical, Dental, Vision and Prescription Drug Plan
401k plan with company match

UHS is 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.

  • UHS is a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc. and a wholly-owned subsidiary of Universal Health Services, Inc. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its management company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiaries of Universal Health Services, Inc. To the extent any reference to "UHS or UHS facilities" on this website including any statements, articles or other publications contained herein relates to our healthcare or management operations it is referring to Universal Health Services' subsidiaries including UHS of Delaware. Further, the terms "we," "us," "our" or "the company" in such context similarly refer to the operations of Universal Health Services' subsidiaries including UHS of Delaware. Any employment referenced in this website is not with Universal Health Services, Inc. but solely with one of its subsidiaries including but not limited to UHS of Delaware, Inc.
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