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Utilization Review Staff - PRN - (12448)

Universal Health Services

Job Code:
Universal Health Services
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Job Details

Deltek Talent Management - Utilization Review Staff - PRN - (12448)

Job Details

Utilization Review Staff - PRN - (12448)

Facility Name
The Ridge Behavioral Health System
LEXINGTON, KY 40509 US (Primary)
Career Area
Behavioral Health - Support Staff
Job Description

About Universal Health Services:


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.


About The Ridge:


The Ridge Behavioral Health System is seeking dynamic and talented Utilization Review Staff. Located in Lexington, KY, the heart of the Bluegrass, The Ridge Behavioral Health System offers a healing environment that is reassuring to a patients’ sense of security and confidentiality. Dedicated to excellence, The Ridge Behavioral Health System is accredited by the Joint Commission on Accreditation of Healthcare Organizations, as a licensed, 110-bed hospital, providing psychiatric (mental health) and chemical dependency (drug & alcohol rehabilitation) services to children, adolescents and adults. Inpatient care is provided on a 24-hour basis, seven days a week. Outpatient and partial hospitalization services are provided on a six-day per week basis, days and evenings. Care is provided according to an established code of ethical conduct and strict adherence to patient rights. The Ridge Behavioral Health System is owned and operated by Universal Health Services. For more information, visit our website at


Position Summary:


The Utilization Review Staff is responsible for managing and coordinating the treatment activities offered to the patient, interface with the treatment team/external case managers/managed care organizations, referring professionals and implementation and supervision of the discharge planning.  Coordinates and tracks all of the admission and continue stay reviews for pre-certifications.  Works closely with Needs Assessment Department and Clinical Treatment Team to carry out its objectives regarding the provision of utilization management for continued stay reviews.


Position Specific Competencies


  • Maintains contact with Assessment staff to stay abreast of admissions.
  • Promptly and accurately obtain data from individuals conducting initial assessment to initiate pre-authorization procedures.
  • Information is organized and presented in a manner, which facilitates third party payer pre-certification process.
  • Advises Assessment staff when clinical criteria have been inadequately documented.
  • Develops and maintains effective working relationships with Assessment staff.
  • Advises doctor of any third party payers requiring direct contact from a physician for admission & concurrent reviews.
  • Is pro-active and independent in gathering information for reviews from the patient record.
  • Takes initiative to seek information from members of the treatment team; monitors documentation to treatment plan goals and alerts team members when documentation is lacking.
  • Attends treatment team meetings to discuss patients who are approaching a review from the third party payer.
  • Implements an effective tracking system to track upcoming reviews.
  • Conducts the reviews in an articulate manner at the appropriate day or at a specified time.
  • Submits any written materials requested by third-party payers within the designated timeframe.
  • Responds to staff requests for information and clarification on UR issues.
  • Effectively maintains records of denied days and statistics on a computer.
  • Prepares any reports assigned or requested by the Director and/or CEO.
  • Assists physicians and staff with medical records questions, problems and requests.
  • Is receptive to direction and feedback from Director.
  • Responds openly and supportively to changes.
  • Approaches co-workers assertively and respectfully; confronts problems in a constructive, solution-oriented manner.
  • Consistently respects the confidential nature of patient and organization information; follows release-of-information policies and procedures; refrains from improperly divulging patient or organization information.
  • Demonstrates effective time-management skills; organizes work so that critical assignments may be completed promptly, accurately and thoroughly.
  • Follows-up on tasks or assignments requiring further attention.
  • Contacts and utilizes corporate resources.
  • Follows proper NCI de-escalation techniques when handling crisis situations.
  • Provides appropriate crisis intervention as necessary by anticipating and responding quickly to escalating behaviors, utilizing de-escalation techniques to diffuse the situation, correctly prioritizing safety concerns.
  • Uses appropriate counseling skills by de-escalating aggression, using active listening skills, using appropriate tone and volume of voice, providing a high frequency and variety of positive reinforcements, maintaining appropriate boundaries, and promoting a positive peer culture.
  • Accepts feedback regarding performance in a reasonable, non-defensive manner.
  • Ensures that patients attend the appropriate level of care or program as indicated on treatment plan or as needed when there are changes in the patient status.
  • Assures discharge planning is reviewed at the time of admission and updated to facilitate effective discharge planning.
  • Effectively schedules all aftercare appointments and documents follow-up appointments on the Interdisciplinary Discharge Plan prior to patient discharges.
  • Facilitates placement referrals for discharge as appropriate.


This opportunity provides the following:


  • *UHS is 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.




Job Requirements

Job Qualifications:



  • Master’s degree in Social work, Psychology, or other Mental Health field is preferred. A Bachelor’s degree in the helping professions or RN is required.


  • One to two years of experience in psychiatric hospital in the Utilization Management department is required.


  • NCI (nonviolent crisis intervention) required.  This training also offered upon hire.
  • CPR certification
  • LPCA, CSW with approved contract for supervision is preferred.  RN Licensure if applicable.

Other Skills

  • Excellent written and verbal communication skills.


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