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Sr. Utilization Review Specialist

Universal Health Services

Job Code:
Universal Health Services
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Job Details

Sr. Utilization Review Specialist

Job Code:  225656
Facility: UHS of Delaware Inc. - Corporate Office
Travel Involved: 0-10%
Job Type: Full Time
Job Level: 
Minimum Education Required: Associate Degree 
Category: Nursing
FTE: 1
Position Summary:
Universal Health Services, Inc. (UHS) knows what it takes to lead, inspire and succeed. One of the nation’s largest and most respected hospital companies, UHS owns and operates through its subsidiaries 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 built an impressive record of achievement and performance, steadily growing from a startup company with zero revenue into a Fortune 500 corporation with annual revenue that exceeds $9 billion. The company's operating philosophy has proven to be effective: Build or acquire high quality hospitals in rapidly growing markets, then invest in the people and equipment needed to allow each facility to thrive and become a dominant healthcare provider in its community.

Headquartered in King of Prussia, PA, UHS ranks on the Fortune 500 list of America's largest corporations with over 74,000 employees, and is consistently listed among Fortune's "Most Admired Companies” and one of the 30 Most Meaningful Companies To Work For in America by Business Insider.

As a member of the UHS Acute Care Division Patient Admission Review Center, supports hospitals in making patient status determination and proper documentation of the patient’s clinical presentation and diagnosis. Reviews the clinical data presented by the hospital and applies evidence based clinical decision support tools to identify options for level of care determinations and corresponding documentation standards. Advises hospitals on applicable patient status criteria and documentation practices that would substantiate the status determination, with clinical decision-making and patient status determinations remaining at all times with the treating providers and hospital at which the patient is located. Collaborates with the treating physician to ensure the patient is placed in the most appropriate status based on the clinical indications documented in the medical record.

Essential Job Duties:

Performs independent, criteria based, documentation assessment, via medical record review and discussion with the physician as needed, on all patients referred.

Applies clinical criteria and guidelines to advise on appropriateness of admission based on the use of relevant evidence based clinical decision support tools and Medicare regulations and guidelines as appropriate.

Accurately correlates clinical based data to hospital approved criteria set.

Applies best practice and standards in the Utilization Review Entry (URE) application of Midas, and as needed within the electronic medical record that supports the appropriate level of care.

Collaborates with the physician when documentation presented does not meet evidenced based medical necessity guidelines to substantiate the patient‘s level of care status selection.
Works directly with the physician advisor to obtain recommendations on cases that require additional information to ensure level of care assigned is clinically appropriate and documents interactions and outcomes with physician advisors in the appropriate area in Midas.

Acts as a resource to the Emergency Department physicians for any issues related to appropriate status assignment of patients.

Maintains up to date knowledge regarding changes within the evidence based clinical decision support tool.

Participates in Quality Reviews and Inter Rater Reliability processes and achieves performance results at or above thresholds established by management.

Associates Degree with a minimum of 5 years experience.
• Case Management experience, and/or Utilization Review, Utilization Management skills in a clinical setting required
• RN with nursing experience in related clinical setting, preferably critical care (ER, ICU) strongly preferred
• Computer proficient with strong typing skills in Microsoft applications specifically Microsoft Word and Excel.
• Working knowledge of current evidence based clinical decision support tools with the ability to apply the criteria consistently and accurately (Interqual experience preferred).
• Ability to accept ownership and accountability for compliance with CMS and UHS best practice guidelines.
• Ability to prioritize, problem solve and multi-task.
• Proficiency in utilizing clinical software programs and electronic medical records.
• Proficient understanding of patient care cost and reimbursement information.
• Excellent phone and communication skills and ability to convey key concepts succinctly and clearly. 

Various shifts available 
Ability to work every other weekend
Potential to work remotely

This position offers a challenging work environment, growth and development; if you are looking for a rewarding career, please take a moment to share your background with us by applying online. UHS offers competitive compensation commensurate with experience and benefits programs including medical, dental, life insurance and 401k.

*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.

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