Utilization Management Case Manager/Appeal Coordinator

The Utilization Management Case Manager/ Appeal Coordinator has responsibility for organizing and conducting the managed care process and managing the appeal 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. In addition, this position is responsible for managing the Appeal Logs, idenitfying cases for appeal and following through to ensure completion of the appeal process.

Benefit Highlights

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300 Subsidiaries!
• Pet Insurance
• Employee Assistance Program (EAP)

• Master’s degree in social work or counseling.
• Fully licensed LPC, LMFT, or LMSW
• Willing to consider Limited Licensed candidates in the above categories with at least one year's related experience.
• A minimum of 2 years of post-graduate related experience in psychiatric or substance abuse treatment required.
• Hospital utilization review/utilization management experience preferred.
• Experience in appeals process preferred.
• Familiarity with managed health care process, medical terminology, experience in case management, discharge planning, and/or utilization review preferred.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.