What are the responsibilities and job description for the UM Case Manager/Appeals Coordinator position at UHS?
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.
For more information, please visit us at www.havenwyckhospital.com
POSITION SUMMARY:
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/facilitate optimal use of hospital resources. In addition, this position is responsible for identifying cases for appeal, submitting those appeals, and tracking their status.
DUTIES AND RESPONSIBILITIES:
- Through clinical skills (experience and knowledge), reports to external insurance and review entities an accurate presentation of the medical management of a patient’s illness, length of stay and care alternatives available within the confines on the client’s benefits and financial resources.
- Communicates with the Treatment Team (physicians, nursing staff, social workers, etc.) as necessary to advocate for the patient’s clinical treatment within the confines on the client’s benefits and financial resources
- Using clinical skills (experience and knowledge) assists the team in ensuring the completeness and accuracy of the medical record.
- Conducts phone, online and fax reviews with managed care providers and relays clinical data in a professional, assertive, clear and organized manner
- Maintains a positive rapport with managed care providers; acts as a representative of Havenwyck Hospital.
- Communicates results of reviews with physicians and team via direct contact, phone calls and chart stickers. Communicates specific criteria and special requirement of managed care regarding discharge planning, family sessions, and treatment plans.
- Refers cases to the Physician Advisor/designee.
- Informs physician of need to contact the managed care reviewers and follows up to ensure call is made and ascertain the number of days obtained.
- Keeps accurate record of days assigned to patients and when the next review is necessary. Keeps accurate accounting of authorized days from admission to discharge.
- Monitors and tracks the certification and re-certification process for Medicare patients to make certain all state and federal reporting guidelines are met.
- Maintains a flow of information by documenting in internal electronic record (MIDAS) any information necessary for treatment team members to follow up on a case.
- Ensures accurate documentation of authorization status and provides appropriate information to the hospital fiscal department to assist in the timely filing of claims, which, in turn, facilitates the accurate and appropriate reimbursement for services rendered.
- Reviews cases on a daily basis, checking for discharges and day hospital admission and relaying pertinent information
- Acts as a facilitator for the provider, payer and patient in utilizing benefits in the most efficient and effectual manner. Has a working knowledge of insurance verification and benefits.
- Possess clinical skills including specific knowledge of diagnosis and dynamics involved in the treatment of psychiatric illnesses for patients of all ages.
- Identifies denied cases and researches appeal process for all payers. Tracks and logs denial reason and appeal status. Prepares appeal letters, submits and tracks status of appeals. Participates and contributes in denial meeting
If you would like to learn more about this position before applying, please contact Havenwyck Hospital at 248-373-9200.
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
- Career development opportunities within UHS and its 300 Subsidiaries
- Free Basic Life Insurance
- Tuition Reimbursement
- Student Loan Repayment Program (for some degrees/restrictions apply)
- SoFi Student Loan Refinancing Program
What do our current employees value at Havenwyck Hospital and UHS?
An environment that puts patient care first. One of the most rewarding aspects of this job is providing excellent care, comfort, and security to the patients and families you treat, 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.
About Universal Health Services
One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 300 corporation, annual revenues were $15.8 billion in 2024. 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 99,000 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 services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com
Qualifications
QUALIFICATIONS:
- Bachelor Degree in social work, psychology, counseling or nursing required. Master’s degree in social work, psychology, or counseling preferred.
- Valid license in the State of Michigan as a Limited or fully licensed (LBSW, RN, LLMSW, LMSW, LLP, TLLP, LPC, LMFT, etc.) required.
- 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 required.
- Familiarity with managed health care process, medical terminology, experience in case management, discharge planning, and/or utilization review preferred.
If you would like to learn more about this position before applying, please contact Havenwyck Hospital at 248-373-9200.
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
- Career development opportunities within UHS and its 300 Subsidiaries
- Free Basic Life Insurance
- Tuition Reimbursement
- Student Loan Repayment Program (for some degrees/restrictions apply)
- SoFi Student Loan Refinancing Program
What do our current employees value at Havenwyck Hospital and UHS?
An environment that puts patient care first. One of the most rewarding aspects of this job is providing excellent care, comfort, and security to the patients and families you treat, 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.
About Universal Health Services
One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 300 corporation, annual revenues were $15.8 billion in 2024. 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 99,000 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 services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com
Salary : $16