Utilization Review Coordinator (Case Management)
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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 70,000 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.
Dover Behavioral Health System is a private psychiatric
facility providing behavioral health care services to
adults and adolescents. DBHS is located in a beautiful
campus setting east of Dover, DE offering inpatient and
partial hospitalization for adolescents and adults.
Treatment includes comprehensive individual assessment;
psychiatric evaluations and medication stabilization;
physical exam and follow up; dual diagnosis programming
and many other services which guide the patient to a
Dover Behavioral Health System is currently seeking a
Full-time Utilization Review Coordinator.
Purpose of Job: To proactively monitor utilization of
continuum services and optimize reimbursement.
Essential Job Duties:
Conduct admission reviews working with Assessment
and Referral Services to stay abreast of admissions.
Conduct concurrent and extended stay reviews on
appropriate day and/or specified time.
Prepare and submit appeals to third party payors,
effectively coordinating collection of all pertinent
data to support the hospital and patient s position.
Maintain and update logs of review and maintain
other appropriate records of the Utilization Review
Stay abreast of applicable UR trends.
Communicate pertinent third party payors issues to
doctor and treatment team.
Attend daily treatment team meetings to discuss
acuity issues, third party payors needs and gather
information for reviews.
Work independently in gathering information for
reviews from the patient record, taking the
initiative to seek information from members of the
Understand and communicate insurance information to
team members, including benefits and levels of care
Perform internal utilization reviews as indicated.
Master s prepared in a behavioral health major or an
actively licensed State of Delaware Registered Nurse.
Experience in UR preferred.