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Utilization Review Nurse, Case Manager - (225656)

Universal Health Services

Job Code:
Universal Health Services
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Job Details

Deltek Talent Management - Utilization Review Nurse, Case Manager - (225656)

Job Details

Utilization Review Nurse, Case Manager - (225656)

Facility Name
KING OF PRUSSIA, PA 19406 US (Primary)
Career Area
Nursing Management
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.

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.

Job Requirements

Associates Degree with a minimum of 5 years experience required,  Case Management experience, and/or Utilization Review required. 

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 strongly required.

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.

If you meet the above requirements and 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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