Utilization Review Manager - Home Care jobs in Wilmington, DE

Rockford Center is a 138-bed mental health facility located in Newark, DE, providing easy access to a full complement of inpatient and partial behavioral health programs for children and adolescents, adults, and older adults.  Rockford is the only child inpatient behavioral health facility in DE, offers an experienced and tenured senior management team, and serves New Castle County and northern Maryland.

Visit us online: https://rockfordcenter.com/

Rockford Center is searching for a talented and patient centric Utilization Review Specialist!

Key Responsibilities include:

• Completes pre-certs and concurrent reviews as assigned, on appropriate day and by the specified time.
• Completes write-ups on new admissions and step-downs/step-ups as assigned, along with the “Change Level of Care” form when applicable.
• Communicates with ARC to gather pre-cert information for new admissions as needed.
• Enters authorizations into the MIDAS by the end of each business day.
• Participates in daily treatment teams: communicates pertinent payor
  information, requests, or concerns; gathers information needed for reviews, and facilitates the signing of Medicare forms when applicable.
• Takes initiative to independently gather additional information for reviews as needed.
• Calls in discharge information to payor by the end of the business day following discharge, or on day of discharge as required by some payors.
• Signs patient treatment plans.
• Communicates to the Director of UR any unplanned or cancelled discharges, denied days, reasons given for underutilized days, and/or any payor-related problems.
• Facilitates physician reviews promptly when a case is denied.
• Maintains and updates appropriate records of the UR Department, including UR Worksheets and treatment team notes.

Benefits for a Utilization Review Specialist include:

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

One of the Nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, our annual revenues were $10.77 billion in 2018. In 2020, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; in 2019, ranked #293 on the Fortune 500; and in 2017, listed #275 in Forbes inaugural ranking of America’s Top 500 Public Companies. Headquartered in King of Prussia, PA, UHS has more than 87,000 employees and through its subsidiaries operates 26 acute care hospitals, 327 behavioral health facilities, 40 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 37 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.

Job Requirements:

• Education:  Master’s prepared Social Worker or Licensed Registered Nurse.

• Experience: Previous experience in Behavioral Health preferred, but not required.

• Additional Requirements:  CPR certification and Completion of Handle With Care training within 90 days of employment. 

Physical and Mental requirements of Job:

Able to stop, crouch, reach, walk, and stand for sustained periods of time; use extremities to press against something with steady force, as well as pull objects, using extremities to draw, drag, haul, or tug in a sustained motion; able to feel, grasp, and finger objects and lift them from a lower to higher position or horizontally from one position to another; express and exchange ideas via spoken or written work to convey detailed information in an audible and quick manner, able to make fine discriminations in sound and to perceive the nature of sounds with no less than a 40lb loss @Hz, 1,000 Hz and 2,000 Hz, with or without correction; able to substantially move wrist, hands and/or fingers in a repetitive motion.

Must be able to exert up to 20 lbs. of force occasionally, and/or up to 10 lbs. of force frequently, and occasionally exert up to 50 lbs. of force.

Visual Acuity:

Visual acuity required adequate for preparing and analyzing data and figures, accounting, transcription, characters on computer terminals, reading, and visual inspections necessary.

Physical Surroundings:

The worker is not substantially exposed to adverse environmental conditions.

Emotional or Mental Stress:

Must be able to work with several distractions including light conversations.  Must be able to deal with aggressive, hostile and irrational behaviors of patients.  Must be able to respond immediately in crisis situations concerning patients and/or family members.

The worker may be subjected to environmental conditions that occur inside and outside via routine travel; much work, however, occurs inside under typical hospital conditions.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills of personnel so classified.

This opportunity provides the following: Challenging and rewarding work environment Growth and development opportunities within UHS and its subsidiaries Competitive Compensation 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. UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via-email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.