Prior Authorization Utilization Review Jobs in Michigan

Skywood Recovery Center is a residential treatment facility offering integrated treatment for addiction and mental health conditions. Skywood Recovery provides individual and group therapy, experiential therapy, equine and art therapy, and yoga. Located in Augusta, MI, a convenient drive from Kalamazoo and Lansing, MI, the campus offers a restorative environment with opportunity to enjoy the outdoors.

Skywood is part of one the nation’s largest and most respected hospital management companies, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, UHS today has annual revenue exceeding $10.7 billion. In 2019, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; in 2018, UHS ranked #268 on the Fortune 500; and in 2017, 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, enabling us to provide compassionate care to our patients and their loved ones: 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 87,000 employees and through its subsidiaries operates 350 inpatient acute care hospitals and behavioral health facilities and 30 outpatient and other facilities located in 37 states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information on the Company, visit our web site: http://www.uhsinc.com.

The Utilization Review Coordinator is responsible for reviewing patient insurance benefits and ascertaining level of care (LOC) pre-certifications.

Essential Duties and Responsibilities

• Reviews and understands insurance information provided by the Admissions Center, determines which benefits are available to client, and clarifies discrepancies or confusion.
• Determines what LOC the client meets and what ASAM (American Society of Addiction Medicine) criteria support that LOC based on patient’s benefits.
• Once a care manager is established, contacts health plan provider and requests most appropriate LOC for client.
• Documents in system and in a paper file the request made and authorization approval number/contact information.
• Attends pass down/treatment team meetings as assigned, reviews weekly UR update information.
• Attends and participates in treatment team meetings and management meetings.
• Coordinates patient’s clinical and after-care needs with treatment team.
• Performs all other duties as required or assigned.

Knowledge, Skills and Abilities

• Must have high level of interpersonal skills. Position continually requires demonstrated poise, professionalism, tact and diplomacy.
• Specific knowledge of substance abuse and or mental health treatment on a clinical level.
• Ability to understand insurance benefits and follow insurance protocols within appropriate time frames.
• Ability to learn levels of care guidelines and medical necessity criteria.
• Must have strong knowledge of a variety of computer software applications in word processing and spreadsheets (MS Word, Excel).
• Excellent organizational skills with the ability to prioritize workload and meet deadlines.
• Ability to pay continual attention to detail in documenting files.
• Understands need for and maintains appropriate confidentiality at all times when interacting with patients, residents, families, visitors, referral sources and all other contacts.
• Exhibits excellent customer relation skills as evidenced by supportive and constructive communication with all contacts including coworkers, patients, residents, visitors, families and referral sources.

Education and Experience

• Nursing degree or Bachelor’s degree in psychology, social work, or related field required or commensurate experience. Master’s degree preferred.
• Minimum of 1 years of experience in utilization review/case management preferred.
• Minimum of 1 year facility based psychiatric/substance abuse experience preferred.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.

The Utilization Review Coordinator is responsible for reviewing patient insurance benefits and ascertaining level of care (LOC) pre-certifications.

Essential Duties and Responsibilities

• Reviews and understands insurance information provided by the Admissions Center, determines which benefits are available to client, and clarifies discrepancies or confusion.
• Determines what LOC the client meets and what ASAM (American Society of Addiction Medicine) criteria support that LOC based on patient’s benefits.
• Once a care manager is established, contacts health plan provider and requests most appropriate LOC for client.
• Documents in system and in a paper file the request made and authorization approval number/contact information.
• Attends pass down/treatment team meetings as assigned, reviews weekly UR update information.
• Attends and participates in treatment team meetings and management meetings.
• Coordinates patient’s clinical and after-care needs with treatment team.
• Performs all other duties as required or assigned.

Knowledge, Skills and Abilities

• Must have high level of interpersonal skills. Position continually requires demonstrated poise, professionalism, tact and diplomacy.
• Specific knowledge of substance abuse and or mental health treatment on a clinical level.
• Ability to understand insurance benefits and follow insurance protocols within appropriate time frames.
• Ability to learn levels of care guidelines and medical necessity criteria.
• Must have strong knowledge of a variety of computer software applications in word processing and spreadsheets (MS Word, Excel).
• Excellent organizational skills with the ability to prioritize workload and meet deadlines.
• Ability to pay continual attention to detail in documenting files.
• Understands need for and maintains appropriate confidentiality at all times when interacting with patients, residents, families, visitors, referral sources and all other contacts.
• Exhibits excellent customer relation skills as evidenced by supportive and constructive communication with all contacts including coworkers, patients, residents, visitors, families and referral sources.

Education and Experience

• Nursing degree or Bachelor’s degree in psychology, social work, or related field required or commensurate experience. Master’s degree preferred.
• Minimum of 1 years of experience in utilization review/case management preferred.
• Minimum of 1 year facility based psychiatric/substance abuse experience preferred.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.