Responsibilities

Utilization Review Manager Opportunity

Emerald Coast Behavioral Hospital provides inpatient treatment services to children, adolescents and adults at our 86-bed facility in Panama City, FL and outpatient services to adolescents and adults at our three outpatient centers located throughout the Florida Panhandle. Additionally, we offer specialized treatment for active duty military members through our Military Resiliency Program, specialized chemical dependency treatment and TMS therapy for chronic depression.

Visit us on-line at: https://emeraldcoastbehavioral.com/

The Utilization Review Manager is responsible for oversight of authorization, appeals, Medicare audits and eligibility determination for all services provided by Emerald Coast Behavioral Hospital. Establishes processes related to authorization approval and insurance verification, and provides training and monitoring to ensure processes are effective. The Utilization Review Manager organizes and directs all activities in compliance with hospital, state, federal and other accrediting and regulatory agency requirements.

Job Duties/Responsibilities:

• Reviews patient charts for continued stay criteria and for quality of care. Review charts concurrently at prescribed intervals and as needed to confirm severity of illness, intensity of services and the need for continued care at the level provided. Negotiates with insurance companies for continued care as required.

• Oversees chart reviews and notifies responsible staff member of deficiencies in documentation and ensures accurately and timely compliance.

• Maintains records of chart reviews, actions and results. Prepares denial reports and communicates information to appropriate parties. Plans, implements and monitors appeals of denied claims ensuring accurate and timely processing. Maintains record of denied claims and appeals.

• Participates in external review and reimbursement activities. Receives authorization for patient coverage from insurance companies. Serves as liaison between insurance companies, referral sources and hospital staff communicating pertinent information.

• Attends treatment team meetings to discuss patients who are approaching a review from a third party payer.

  Benefit Highlights:

• Challenging and rewarding work environment

• Competitive Compensation & Generous Paid Time Off

• Excellent Medical, Dental, Vision and Prescription Drug Plan

• 401(K) with company match and discounted stock plan

• SoFi Student Loan Refinancing Program

• Career development opportunities within UHS and its 300+ Subsidiaries!

• More information is available on our Benefits Guest Website: benefits.uhsguest.com (https://urldefense.com/v3/__http:/benefits.uhsguest.com__;!!OPumOOY!LESmM5gXhzV_CHynAC4xuBwbiziVj9coqpLEQWiQ5z7oVHquGGj54MrpWvQQ1WAGAvddDK7cPgk6O34etVYL040C_OHMTPB9$)

  One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. 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. 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

  Requirements:

• Graduate of an accredited RN Program or Master’s Degree in Social Work, Psychology, Counseling, or other Human Service field.

• Active Florida State license as appropriate

• Five (5) years clinical experience with a psychiatric mental health population preferred. Three (3) years experience in Utilization Review preferred. Supervisor 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.

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  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.

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