One of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. In 2017, UHS was recognized as one of the World's Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America's Top 500 Public Companies.
Our operating philosophy is as effective today as it was 40 years ago: Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve.
Headquartered in King of Prussia, PA, UHS has more than 81,000 employees and through its subsidiaries operates more than 320 acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom.
As a Utilization Review Specialist you will:
Reviews and understands insurance information provided by the Admissions Center, determines which benefits are available to client, and clarifies discrepancies or confusion.
Provides a thorough face-to-face interview/assessment upon admission or soon thereafter.
Determines what LOC the client meets and what ASAM (American Society of Addiction Medicine) criteria support that LOC based on patient's benefits.
Once a care manager is established, contacts health plan provider and requests most appropriate LOC for client.
Documents in system and in a paper file the request made and authorization approval number/contact information.
Attends pass down/treatment team meetings as assigned, reviews weekly UR update information.
Attends and participates in treatment team meetings and FLASH meetings.
Coordinates patient's clinical and after-care needs with treatment team.
Performs all other duties as required or assigned.
Knowledge, Skills and Abilities
Ability to inspire client confidence in the FRN Staff and the FRN Model of Treatment.
Ability to consistently demonstrate through conduct and communications the stability required to effectively assist patients and their family members through the FRN Model of Treatment.
Excellent verbal and written communication skills required.
Must have high level of interpersonal skills. Position continually requires demonstrated poise, professionalism, tact and diplomacy.
Specific knowledge of substance abuse and or mental health treatment on a clinical level.
Ability to understand insurance benefits and follow insurance protocols within appropriate time frames.
Ability to learn levels of care guidelines and medical necessity criteria.
Must have strong knowledge of a variety of computer software applications in word processing and spreadsheets (MS Word, Excel).
Excellent organizational skills with the ability to prioritize workload and meet deadlines.
Ability to pay continual attention to detail in documenting files.
Understands need for and maintains appropriate confidentiality at all times when interacting with patients, residents, families, visitors, referral sources and all other contacts.
Exhibits excellent customer relation skills as evidenced by supportive and constructive communication with all contacts including coworkers, patients, residents, visitors, families and referral sources.