Utilization Management Case Mgr

Responsibilities HAVENWYCK HOSPITAL (a UHS facility) Havenwyck Hospital is a Joint Commission-accredited and licensed psychiatric hospital, overlooking Lake Galloway in Auburn Hills, Michigan. We specialize in providing comprehensive, compassionate behavioral health services to children, adolescents and adults. It is the ultimate goal of our dedicated staff to build strength, confidence and knowledge within each patient, in hopes that they may continue learning and understanding their needs and practicing self-care for the rest of their lives. If you would like to learn more about this position before applying, please contact Havenwyck Hospital at 248-373-9200.POSITION SUMMARY:The Utilization Management Coordinator has responsibility for organizing and conducting the managed care process. These duties shall be directed toward supporting the hospital's mission in the pursuit of excellence in care/service and will include (but not limited to): conducting timely admission and continued stay record reviews with external payers, utilizing approved criteria to make determinations of medical necessity and level of care planning, verifying active treatment by completing internal audit reviews within approved time frames, assisting the treatment team when indicated in the discharge planning process, and acting as liaison with MD/Clinical Treatment Team and external agencies. Report authorizations, denials, and documentation concerns, as well as collaborate effectively across departments to minimize denials/faciliate optimal use of hospital resources.Through experience and knowledge, reports to external insurance and review entities an accurate presentation of the medical management of a patient’s illness, length of stay and care alternatives available within the confines on the client’s benefits and financial resources.Communicates with physicians, nursing staff, social workers and treatment team members as necessary to clarify patient’s clinical status and continued stay or discharge.Conducts phone, online and fax reviews with managed care providers and relays clinical data in a professional, assertive, clear and organized manner.Maintains a positive rapport with managed care providers; acts as a representative of Havenwyck Hospital.Communicates results of reviews with physicians and team via direct contact, phone calls and chart stickers. Communicates specific criteria and special requirement of managed care regarding discharge planning, family sessions, and treatment plans.Refers cases to the Physician Advisor/designee.Informs physician of need to contact the managed care reviewers and follows up to ensure call is made and ascertain the number of days obtained.Keeps accurate record of days assigned to patients and when the next review is necessary.Keeps accurate accounting of authorized days from admission to discharge.Monitors and tracks the certification and re-certification process for Medicare patients to make certain all state and federal reporting guidelines are met.Maintains a flow of information by documenting any information necessary to follow up on a case.Ensures accurate documentation of authorization status.Reviews cases on a daily basis, checking for discharges and day hospital admission and relaying pertinent informationActs as a facilitator for the provider, payor and patient in utilizing benefits in the most efficient and effectual manner.Has a working knowledge of insurance verification and benefits.Possess clinical skills including specific knowledge of diagnosis and dynamics involved in the treatment of psychiatric illnesses for patients of all ages.BENEFIT HIGHLIGHTS: Challenging and rewarding work environmentCompetitive Compensation & Generous Paid Time OffExcellent Medical, Dental, Vision and Prescription Drug Plan401(K) with company match and discounted stock planCareer development opportunities within UHS and its 300+ SubsidiariesFree Basic Life InsuranceTuition ReimbursementSoFi Student Loan Refinancing ProgramStudent Loan Repayment Program - for some degrees and criteriaWhat do our current employees value at Havenwyck Hospital and UHS? An environment that puts patient care first. One of the most rewarding aspects of this job is providing excellent care, comfort, and security to the patients and families you treat, at their most vulnerable times. Supportive and responsive leadership. You are never alone, as you are part of a large network of peer co-workers that routinely exchange ideas and review current topics within the industry. Having the opportunity to grow, learn, and advance in your career. There are very robust continuing education options and opportunities for skills diversification and career advancement with UHS.  About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 300 corporation, annual revenues were $15.8 billion in 2024. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies.Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com Qualifications QUALITICATIONS:Bachelor Degree in social work, psychology, counseling or nursing required. Master's degree in social work, psychology, or counseling preferred. Limited or fully licensed (LBSW, RN, LLMSW, LLP, TLLP, LPC, LMFT, etc.).A minimum of 2 years of post-graduate related experience in psychiatric or substance abuse treatment required. Hospital utilization review/utilization management experience preferred.Familiarity with manager health care process, medical terminology, experience in case management, discharge planning, and/or utilization review 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. Avoid and Report Recruitment Scams At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.