Utilization Management – Precertification Specialist

Job Description

Responsibilities

Utilization Management - Precertification Specialist

HAVENWYCK HOSPITAL (a UHS facility)

Havenwyck Hospital s 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.

POSITION SUMMARY :

The Utilization Management Precertification Specialist has responsibility for obtaining prior authorizations for Inpatient and Partial Hospital Program services by successfully completing the authorization process with all commercial payers.

The position will provide daily coverage to complete admission and step-down precertifications, track Medicare certifications, and submit discharges to various payers.

These duties shall be directed toward supporting the hospital's mission in the pursuit of excellence in care / service and will include (but is not limited to) : conducting timely admission and step-down precertification with external payers, obtaining Medicare Certifications from Physicians, and submitting discharges to various payers.

Report initial authorizations, denials, and documentation concerns, as well as collaborate effectively across departments to minimize denials / faciliate optimal use of hospital resources.

Duties will include :

• Through clinical skills (experience and knowledge), reports to external insurance and review entities an accurate presentation of the presenting symptoms / medical management of a patient’s illness.
• Research patient benefits and payer precertification requirements and obtains initial authorizations via payer website, fax, or by phone, as well as follows up regularly on pending cases.

Relays clinical data in a professional, assertive, clear, and organized manner.

Gathers patient discharge information from all units daily. Double checks accuracy of aftercare appointment address and phone number.

Enters patient discharge data in various payer systems in a timely manner and updates MIDAS as needed. Faxes / mails discharge packets.

• Maintains a positive rapport with managed care providers; acts as a representative of Havenwyck Hospital.
• Runs Medicare Compliance Reports, tracks and records completion of Medicare Certificates, as well as Admission and Discharge Important Message from Medicare, uploads Medicare Certificates and updates MIDAS certification and Medicare Screens appropriately.

If you would like to learn more about this position before applying, please contact Havenwyck Hospital at 0.

BENEFIT HIGHLIGHTS :

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plan

K) with company match and discounted stock plan

• Career development opportunities within UHS and its + Subsidiaries
• Free Basic Life Insurance
• Tuition Reimbursement
• SoFi Student Loan Refinancing Program

What do our current employees value at Havenwyck Hospital & UHS?

An environment that puts patient care first. One of the most rewarding aspects of working at Havenwyck Hospital is being part of a team that's providing excellent care, comfort, and security to patients and families, 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.

Universal Health Services (UHS) :

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. Growing steadily since its inception into an esteemed Fortune corporation, annual revenues were $.

3 billion in 3. 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 , 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

Qualifications

• High School Diploma or Equivalent required. Bachelor’s degree in social work, psychology, counseling, or related field preferred.
• Experience working in a hospital setting or clinic performing clerical functions required.
• Must be proficient in Excel and Word applications.
• Familiarity with managed health care process and medical terminology.
• A minimum of one year of experience in psychiatric (inpatient or partial hospitalization), substance abuse treatment, or medical setting preferred.
• Prior authorization experience in a hospital setting preferred.
30+ days ago