7 hours

Utilization Review Case Manager PRN - (236523)

Universal Health Services
  • Job Code
Deltek Talent Management - Utilization Review Case Manager PRN - (236523)

Job Details

Utilization Review Case Manager PRN - (236523)

Facility Name
River Point Behavioral Health
JACKSONVILLE, FL 32216 US (Primary)
Career Area
Job Description

Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected health care management companies, operating through its subsidiaries acute care hospitals, behavioral health facilities and ambulatory centers nationwide. Founded in 1978, UHS subsidiaries now have more than 65,000 employees. The UHS business strategy is to build or purchase health care properties in rapidly growing markets and create a strong franchise based on exceptional service and effective cost control. Our success comes from a responsive management style and a service philosophy based on integrity, competence and compassion River Point Behavioral Health is a 93-bed treatment facility that specializes in quality behavioral health and substance abuse services foradults and seniors. We offer a full continuum of care through an integrated system of inpatient, residential, partial hospitalization and intensive outpatient programs. Progressive professionals in the fields of psychiatry, medicine, nursing, social services, education and activity therapy provide our comprehensive services. Job duties for the Utilization Review Coordinator includes the following: Conducts admissions and concurrent reviews for patients admitted to the facility Obtains admission information from E&R and Insurance Verification/Benefits information from the Admissions department Reviews chart and conducts precertifications and concurrent reviews with third party payors as required within specified time limits Communicates results of reviews to the physicians and other treatment team members in treatment team and daily flash meetings Maintains internal departmental logs Prepares patient discharge list for treatment team and daily flash meetings Completes all paperwork related to pre-certification and concurrent reviews according to UR Department policies Enters results of reviews into HMS Informs physicians, treatment team members, Director of UR, and Business Offices when specific problems arise with certification and on all denials Coordinates and participates in the treatment planning process and meetings Monitors documentation to ensure components of care are adequately addressed and documented Monitors the discharge planning process and works closely with discharge planners Ensures wellness check forms are filled out for every patient at the time of discharge Monitors documentation for medical necessity criteria and alerts team members when documentation is lacking Communicates insurance company requirements and/or requests for additional information to treatment team Conducts an ongoing review of the clinical chart to ensure effective implementation and documentation of all treatment interventions Interfaces with the outpatient staff to facilitate a smooth transition at the time of transfer Informs physician, other treatment team members and hospital staff when there is a denial of certification Effectively monitors physician to physician reviews Facilitates Peer Review as outlined in Utilization Management Plan Reviews chart at admission for documentation of medical necessity for acute care Assures discharge planning is reviewed at the time of admission and updated weekly Effectively schedules all psychiatric aftercare appointments within 7 days of discharge Precertifies PHP/IOP or inpatient acute for level of care patients Documents follow-up appointments on the Nursing Discharge Form prior to patient discharges Faxes psychiatric documentation to the next care provider upon discharge when releases permit and specify Completes, submits, and follows up on retrospective reviews and appeals of denied days with insurance companies Enters denial information on the denial log and submits write off forms to the B.O. as necessary Submits data to SAMH and DCF as required by contract Ensures Medicare cert/recert forms are signed according to Medicare guidelines

Job Requirements

Qualified candidates must have the following: * Must have a Master's Degree in a field related to behavioral health or aRegistered Nurse * Prefer at


  • Insurance
  • Healthcare

Universal Health Services

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Universal Health Services
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