Medical Claims Review Manager jobs in New London, CT

Are you caring, compassionate and hardworking? Our facility can provide a place for you to thrive and continue your professional development.

Stonington Institute, a division of one of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS), has an immediate opening for a full-time UR Specialist.

Stonington Institute is committed to providing quality substance abuse treatment options for adults in Southeastern Connecticut and surrounding areas. We offer medical detox as well as residential addictions treatment for active duty and retired military service members in our North Stonington location. Our clinic in Groton, CT, offers partial hospitalization and intensive outpatient treatment, and is conveniently located across the street from The Inn at Trails Corner, a new 180 bed dormitory-style sober community for adult men and women who attend our outpatient day treatment programs. The Inn offers overnight accommodations, full-meal service, indoor/outdoor recreation options, a workout room, and computer center for all clients. We accept private insurance, state-funded plans and self-pay arrangements.

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.

The Utilization Review Specialist is responsible for the pre-certification, concurrent, and discharge review process for clients at all levels of care, resulting in the approval of their admission and continued treatment.

• Consult with Admissions Department regarding specific LOC issues, insurance requests, and/or criteria questions.
• Complete initial precertification for all levels of care.
• Knowledge of UR processes required for all payor sources i.e. precertification, concurrent reviews, discharge review.
• Conduct concurrent reviews on assigned cases.
• Ability to identify and advocate for a particular level of care based on the presenting clinical information.
• Coordinate with colleagues and payors regarding client changes in level of care internally or transitions to other internal programs.
• Collaborate with clinicians/case managers to obtain pertinent clinical and discharge information.
• Learn UR Tracking System, Midas; enter daily authorizations and/or other necessary information in a timely manner.
• Print and monitor UR reports on a daily basis.
• Document and file all authorization information accurately and completely.
• Address client insurance changes immediately and communicate results to appropriate departments.
• Ensure that all applicable information is communicated to the Billing Department on a daily basis.
• Notify UR Department Head and Billing of any denials and complete telephonic or written appeals when necessary.
• Liaison between insurance and clinical staff, providing information to clinicians/case managers regarding dispositions that would be approved by insurance.
• Participate in monthly UR Meeting.

Stonington Institute employees receive great opportunities.

• Challenging and rewarding work environment
• Career advancement opportunities
• Comprehensive Benefits including Medical, Dental, Vision, Company matching 401K, Tuition Reimbursement & Tuition savings to continue your nursing education with Chamberlain University, SoFi Student Loan Refinancing Program, and more (for eligible part-time and full-time positions)
• Competitive Compensation

Apply today to join our amazing team!

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.

We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: or 1-800-852-3449.

Masters Degree preferred; minimum Bachelors Degree in Psychology or related Human Service Field or RN. Knowledge of Utilization Review Processes, insurance plans, mental health and chemical dependency treatment. Knowledge of various treatment levels of care as well as psychiatric diagnosis. Experience with computer skills preferred.