Utilization Review Manager - Home Care jobs in Pensacola, FL

Utilization Review Specialist Opportunity

Emerald Coast Behavioral Hospital provides inpatient treatment services to children, adolescents and adults at our 86-bed facility in Panama City, FL and outpatient services to adolescents and adults at our three outpatient centers located throughout the Florida Panhandle. Additionally, we offer specialized treatment for active duty military members through our Military Resiliency Program, specialized chemical dependency treatment and TMS therapy for chronic depression.

Visit us on-line at: https://emeraldcoastbehavioral.com/

The Utilization Specialist facilitates optimal reimbursement through accurate certification and complete chart documentation. Conducts concurrent admission and continued stay reviews based on utilization review criteria. Refers and consults with the Social Services to promote appropriate continued stay or discharge in the absence of definitive documentation and/or review criteria to support hospital stay.

Job Duties/Responsibilities:

• Facilitate optimal reimbursement through certification process. Conduct concurrent admission and continued stay reviews based on utilization review criteria. Obtain initial certifications for urgent and emergent admissions with zero error rate. Obtain continued stay certification with zero error rate.
• Follow-up of all outstanding cases. Communicate 100% of identified case problems to appropriate level. Assess presence of Severity of Illness/Intensity of Service criteria.
• Participate as active partner with Physician, Nursing, and Social Services in treatment team. Refer consults with Social Services to promote appropriate continued stay or discharge. Refer to and consults with other internal staff as needed to facilitate accurate documentation and assure appropriate, timely discharge
• Communicate 100% of concurrent denial case status to Social Services and attending Physician. Check Physician order on chart for match to billing status. Contact Physician to obtain order for clarification of appropriate patient status.
• Communicate with third party payers by providing clinical information (via e-mail, phone or fax) in accordance with established standards, policies and procedures.
• Enter authorization and days approved data into financial and clinical information systems to facilitate hospital billing.
• Ensure all peer reviews are completed according to insurance specifications.
• Audits Medicare charts according to LCD standards. Ensures Medicare certifications are timely and accurate. Report’s findings to appropriate parties. Makes recommendations for solution.
• Manage all denied days be completing appeal letters with copies of patient chart within 14 days of appeal. Follow-ups on all appeals for resolution. Maintains denial log.
• Works within the organization’s utilization management plan in accordance with the mission and strategic goals of the organization, federal and state law and regulations, and accreditation standards
• Conducts concurrent reviews, prepares and presents reports and communicates pertinent information to leadership team when needed.

Benefit Highlights:

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plan
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300 Subsidiaries!

Who we are:

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. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $13.4 billion in 2022. 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. Headquartered in King of Prussia, PA, UHS has approximately 94,000 employees and continues to grow through its subsidiaries. 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. www.uhs.com

Requirements:

• Graduate from an LPN Program, Associates Degree in Nursing or Diploma RN or Master’s Degree in Social Work, Psychology, Counseling or other Human Service field required.
• Active Florida State license as RN or LPN required if RN or LPN
• 2 years acute care experience in a behavioral health setting preferred.
• Ability to work at our Okaloosa Outpatient Center located in Fort Walton Beach, Fl.

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: https://uhs.alertline.com or 1-800-852-3449.