Utilization Review Social Worker Jobs in Virginia

Responsibilities
The Hughes Center is a highly-structured psychiatric residential treatment facility for youth ages 10 to 22 with neurodevelopmental disorders. The Hughes Center also provides private, community-based educational services. We provide both individualized and holistic care for adolescents and young adults with intellectual and developmental disabilities in a nurturing, family-friendly environment. We utilize a multidisciplinary team approach to provide comprehensive evaluations and evidence-based treatment (and educational) interventions with the intent to increase each youth's level of functional independence. Our team also works diligently to address or manage medical conditions and challenging behaviors that are often associated with individuals who are diagnosed with neurodevelopmental disorders. We challenge our residents to adapt to and apply learned skills within new environments and situations, and to maintain functional use of these skills when they return to their homes or other community-based settings.
Position Purpose: Serves as provider for resident-centered services that promote coordinated, effective treatment by facilitating the communication exchange between referral source, physician/treatment team and payor and managing timely transitions through the phases of residential care.
Qualifications
Key
Responsibilities:
• Facilitates communication regarding resident treatment process and needs with referral sources and payor.
• Keeps accurate records of the authorizations for residents in treatment.
• Ensures coordinated effective resident care including admission, continued stays, and discharge requirements.
• Ensures positive relationships with external and internal customers.
• When appropriate, travel to resident's community representing the facility at FAPT meetings and court hearings.
• Ensures continued availability (recertification) of financial resources throughout the residents' stay.
• Develop systems to review and respond to concerns expressed by customers. Together with the appropriate Department head, he/she works to resolve issues to satisfaction of the customer and facility.
• Review of clinical patient data with third party reviewers to substantiate the need for continued hospital level of care of ongoing participation in treatment programs.
• Communicate and coordinate third party reviewer's level of care decisions and expectations to appropriate clinical and administrative staff.
• Assist in preparing Utilization Review Reports as necessary.
• Coordinates and makes Retrospective Appeals to third party payers.
• Meets weekly with Administrator on appropriate issues.
• Other duties as assigned based on the needs of the facility.
Qualifications: Skills, Knowledge and Abilities
Needs basic understanding of and comfort level with medical terminology, residential treatment, clinical science/pathology and psychiatric disorders. Must know how to gather and analyze data. Must be articulate, assertive, and able to communicate effectively with families, payors, therapists and physicians both verbally and in writing. Must also demonstrate initiative, tact and good judgement. Must be able to acquire clear understanding of treatment priorities and ability to make sound decisions balancing resident and family needs with available resources. Must have basic computer skills.
Education: A bachelors degree required; masters degress preferred (Social work, Counseling, Nursing)
A minimum of three (3) years direct clinical experience in a psychiatric or mental health setting. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.
Licensure: LMHC, LPC, LMSW, LCSW, or RN preferred.
Physical
Requirements: Must be able to mentally handle stressful and quick changing situations. Must have normal auditory processing. Must have clear verbal speech with no impediments. 50% of time, incumbent is seated and talking
Benefits: https://benefits.uhsguest.com/

• Home/Work Life Balance
• Excellent Medical, Dental, Vision, and Prescription Drug plans
• 401(k) Retirement Plan with company match
• Life Insurance
• Flexible Spending or Health Savings Account
• Generous Paid Time Off
• Career Development Opportunities within UHS and its subsidiaries
• A Challenging and Rewarding Work Environment
• Free meals!
• Company stock purchase discount
• Employee Assistance Program

The Hughes Center is a drug-free and alcohol-free workplace. A pre-hire drug screen, pre-hire background checks, and education verification are required of all new employees.
Pay Transparency:
To encourage pay transparency, promote pay equity, and proactively address regulations, UHS and all our subsidiaries will comply with all applicable state or local laws or regulations which require employers to provide wage or salary range information to job applicants and employees. Salary offers may be based on key factors such as education and related experience.