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Utilization Management Case Manager- PRN As Needed - (20434)

Universal Health Services


Location:
AUBURN HILLS, MI
Date:
02/23/2018
2018-02-232018-03-24
Job Code:
20434
Universal Health Services
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Job Details

Deltek Talent Management - Utilization Management Case Manager- PRN As Needed - (20434)

Job Details


Utilization Management Case Manager- PRN As Needed - (20434)

Facility Name
Havenwyck Hospital
Location
AUBURN HILLS, MI 48326 US (Primary)
Career Area
Professional
Category
Other
Job Description

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.

Mission Statement: To provide individualized, quality behavioral health care, in a safe and secure environment where dignity and respect are upheld by our team of dedicated, caring, professional staff, in a cost-effective manner.

Havenwyck Hospital is a 243 bed, Joint Commission accredited and licensed psychiatric and substance abuse facility. We specializing in providing behavioral health and substance abuse treatment and are located in Auburn Hills overlooking Lake Galloway. 

Havenwyck Hospital provides a continuum of individualized treatment to children, adolescents and adults needing psychiatric and/or substance abuse treatment. Havenwyck strives to create a customized treatment plan for each individual based on level of maturity, life experiences, needs and other factors. Patients at Havenwyck are treated by a qualified multi-disciplinary team, including, but not limited to, a psychiatrist, registered nurses, social workers and recreational therapists, in a warm, supportive environment. Havenwyck Hospital's Residential Treatment Center is a secure treatment program for children and adolescents ages 8 to 17, with emotional and/or behavioral impairments that require them to be in a secure, 24-hour supervised therapeutic living situation. For more information, please visit our website at havenwyckhospital.com. 

Havenwyck Hospital is seeking a dynamic and talented Utilization Management Case Manager to join our team of compassionate, dedicated professionals.

The Utilization Management Case Manager has responsibility for organizing and conducting the managed care process. These duties shall be directed toward supporting the hospital's mission in the pursuit of excellence in care/service and will include (but not limited to): conducting timely admission and continued stay record reviews with external payers,  utilizing approved criteria to make determinations of medical necessity and level of care planning, verifying active treatment by completing internal audit reviews within approved time frames, assisting the treatment team when indicated in the discharge planning process, and acting as liaison with MD/Clinical Treatment Team and external agencies. Report authorizations, denials, and documentation concerns, as well as collaborate effectively across departments to minimize denials/facilitate optimal use of hospital resources.

Key responsibilities include:

  • Using Clinical judgment, acts as a liaison between the hospital care team and to external entities an accurate presentation of the medical management of a patient’s illness, length of stay and care alternatives available within the confines on the client’s benefits and financial resources. Relays clinical data in a professional, assertive, clear and organized manner.
  • Communicates with the Treatment Team (physicians, nursing staff, social workers, etc.) as necessary to advocate for the patient’s clinical treatment within the confines on the client’s benefits and financial resources.
  • Maintains a positive and professional rapport with managed care providers; acts as a representative of Havenwyck Hospital.
  • Communicates accurate results of reviews with the Treatment Team. Communicates specific criteria and any special requirements of external payers regarding treatment planning.
  • Refers cases to the Physician Advisor/designee.
  • Informs physician of need to contact the managed care reviewers and follows up to ensure call is made and ascertain the number of days obtained.
  • Maintains in data systems an accurate record of days certified for patients. 
  • Has a working knowledge of insurance verification and benefits.
Job Requirements
  • Masters degree in social work, psychology, or counseling; or a Bachelors degree in nursing.
  • Valid and unrestricted license (RN, LMSW, LLP, LPC, etc.). 
  • A minimum of 2 years of post-graduate related experience in psychiatric or substance abuse treatment. 
  • Experience in settings that include inpatient or partial hospitalization preferred. 
  • Familiarity with managed health care process, medical terminology, experience in case management, discharge planning, and/or utilization review preferred.
  • Employee must be in good standing (evaluation/employment history, corrective action, etc.) to be considered for internal transfer.

 

This opportunity provides the following: 

  • Meaningful work, saving patient lives
  • Healthy, respectful and team-based 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.

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