Clinical Utilization Management Specialist

2 months ago


Sacramento, California, United States Universal Health Services Full time
Job Summary

We are seeking a highly skilled Clinical Utilization Management Specialist to join our team at Universal Health Services. As a key member of our multidisciplinary treatment team, you will play a critical role in ensuring the optimal utilization of healthcare resources while promoting positive patient outcomes.

Key Responsibilities
  • Timely Clinical Reviews: Perform daily clinical reviews with all payer types to secure authorization for continued treatment based on payer criteria.
  • Level of Care Requirements: Educate and guide the treatment team on level of care requirements and payer expectations for patient acuity and appropriate utilization.
  • Quality and Timely Appeals: Complete quality and timely appeal/denial letters, and participate in post-claim recovery review and ongoing audit activity to ensure compliance with CMS and other regulators.
Requirements
  • Education: Bachelor's degree from an accredited college or university in nursing, or Master's degree in social work, mental health, or a related field.
  • Experience: Minimum of one year of experience with communication with external review organizations or comparable entities, or four years of direct clinical experience in a psychiatric or mental health setting.
  • Licensure: RN, LCSW, MFT, MSW degree, or LPT.
About Universal Health Services

Universal Health Services is one of the nation's largest and most respected providers of hospital and healthcare services. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates.



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