What are the responsibilities and job description for the Utilization Management Appeals Coordinator - Full Time (HYBRID) position at UHS?
Hartgrove Behavioral Health System is a 160-bed leading psychiatric hospital dedicated to providing quality behavioral health services for its diverse population of children, adolescents and adults. Hartgrove Hospital has become the flagship behavioral health facility within Universal Health Services, Inc., its parent company. As a leader in behavioral health within UHS and in the Chicago area, Hartgrove Hospital is a state-of-the-art facility offering some of the most advanced technologies and programs found in the behavioral health field. We are dedicated to our teamwork approach and provide a compassionate and therapeutic environment, as well as offering a continuum of specialty programs throughout our inpatient, partial and outpatient services.
JOB SUMMARY: The UM Appeals Coordinator is responsible for all denial and appeal activities for the Utilization Management department, including Expedited Appeals, Standard Appeals, External Independent Reviews, Retrospective Reviews, and State Fair Hearings.
Tasks include:
- Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested. Prepare letters for member and provider appeals that did not meet criteria.
- Gather, analyze, and report information regarding member and provider appeals.
- Maintain files and logs for all appeals.
- Follow all appeals and retrospective reviews through resolutions.
- Remain current on applicable UM trends and regulations and review current policies and procedures for compliance.
- Work closely with the Business Office to ensure proof of authorization and denials communicated accurately in Midas.
- Interface with various managed care organizations and other payers to resolve issues related to appeals.
- Maintain all records/data pertaining to the Utilization Management Program.
- Actively participate in Utilization Management/Medical Records Committee meetings including presentation of reports, statistics, etc.
- Participate in the hospital-wide Quality Assurance Program.
A Career with Hartgrove Behavioral Health System Offers....
- A rewarding career improving the lives of adults and youth
- Highly competitive wages & shift differentials
- Career advancement and mobility
- An engaged leadership team with a commitment to patient and staff safety
- And much more!
For information about the benefits we offer, please visit UHS Benefits Service Center.
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 since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
Qualifications
JOB SPECIFICATIONS: To perform this job successfully, an individual must be able to perform each primary duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.
Education: Bachelor’s Degree in behavioral health related field required; Master Degree preferred.
Experience: 1 year experience in Utilization Management and 1 year experience in mental health/psychiatry preferred.
Knowledge: Possesses knowledge of utilization review, insurance and managed care procedures. Current knowledge of regulating /accrediting agency guidelines. Basic knowledge of computer skills and statistical analysis desired. Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines - Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Effective oral and written communication skills to support patient advocacy/negotiating skills to ensure quality reviews with payers.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
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