250,000+ live roles 14,000+ active employers ✦ 420+ posted in 24h California market · 19,818 jobs Texas market · 17,364 jobs Florida market · 15,465 jobs New York market · 12,783 jobs California jobs · 19,818 Texas jobs · 17,364 Florida jobs · 15,465 New York jobs · 12,783 Healthcare · 113,756 jobs Patient Care · 105,408 jobs BLS · 50,683 jobs Registered Nurse · 46,138 jobs Documentation · 25,581 jobs CPR · 23,581 jobs 250,000+ live roles 14,000+ active employers ✦ 420+ posted in 24h California market · 19,818 jobs Texas market · 17,364 jobs Florida market · 15,465 jobs New York market · 12,783 jobs California jobs · 19,818 Texas jobs · 17,364 Florida jobs · 15,465 New York jobs · 12,783 Healthcare · 113,756 jobs Patient Care · 105,408 jobs BLS · 50,683 jobs Registered Nurse · 46,138 jobs Documentation · 25,581 jobs CPR · 23,581 jobs

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Utilization & Review Clinician (MSW)

Quick overview

The Utilization Review Clinician manages, reviews, and monitors resource utilization for patients to maximize care effectiveness by evaluating clinical appropriateness. This role acts as a liaison between payors, the business office, and the treatment team to ensure optimal patient care and reimbursement, including securing authorizations for services.

Requirements summary

Candidates must possess a Master’s degree in social work, mental health, or a related field, along with either one year of experience communicating with external review organizations or four years of direct clinical experience in a psychiatric setting. Prior experience with prior authorizations or Case Management is mandatory.

postgraduate degreeTreatment PlanningCoordination Of CareLiaisonSocial WorkUtilization ReviewDenial ManagementAuthorization ManagementPre-authorizationPayor CommunicationClinical Appropriateness EvaluationInsurance Benefit Communication

Job description

Responsibilities

Heritage Oaks Hospital is part of the UHS Family of Providers which has been highly regarded as an integral part of the greater Sacramento and Northern California mental health system since 1988.
Conveniently located in northern Sacramento, Heritage Oaks is a fully accredited, 125-bed acute psychiatric hospital offering a full range of individually tailored treatment services to adolescents, adults, and senior adults, including treatment for substance abuse and chemical dependency issues with drugs and alcohol.
Heritage Oaks is a Medicare provider in addition to contracts with most commercial health insurance plans.
Heritage Oaks has three outpatient centers as part of the Branches Outpatient of the greater Sacramento.
Providing partial hospitalization programs (PHP) and intensive outpatient programs (IOP) to support patients on their road to wellness.
We are committed to providing service excellence to all and ensuring our patients receive the optimal level of care that will be most beneficial to their health and recovery.

Website

https://heritageoakshospital.com/ The Utilization Review Clinician is responsible for the managing, reviewing and monitoring the utilization of resources related to the patient and to maximize effectiveness of care by evaluating clinical appropriateness. The Utilization Review Clinician functions as liaison between payors, the business office, and treatment team, providing information and feedback to assist in optimum patient care and reimbursement. The UR Clinician will also review with payor sources and receive authorization for the type and volume of services through all levels of care and aftercare review. Works cooperatively with Assessment & Referral in establishing clinical pre-authorization. Communicates with the business office regarding any information pertaining to insurance benefits and coverage. Attend treatment planning meetings and oversee the coordination of care for patients in respect to the available financial resources which includes notifying attending physician/treatment team of actual or potential denial.
Heritage
Oaks offers comprehensive benefits such as: Competitive Compensation Excellent Medical, Dental, Vision, and Prescription Drug Plan Generous Paid Time Off 401(K) with company match and discounted stock plan Career development opportunities within UHS and its Subsidiaries Education Assistance Challenging and rewarding work environment

Benefits

Dental Insurance
Paid Time Off
Vision Insurance
Medical Insurance
Competitive Compensation
Prescription Drug Plan
Education Assistance
Career Development Opportunities
Discounted Stock Plan
401(K) With Company Match

MSW degree
Additional
Requirements: Trained in Handle with Care (HWC) within the first 30 days of employment. Training provided by HOH. CPR certification required. About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues exceeding $11 billion in 2019. In 2020, UHS was again recognized as one of the World’s Most Admired Companies by Fortune on the Fortune 500; and recognized in Forbes ranking of America’s Top 500 Public Companies. Headquartered in King of Prussia, PA, UHS has over90,000 employees and through its subsidiaries operates 26 acute care hospitals, 328 behavioral health facilities, 42 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 37 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. 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 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.

Utilization & Review Clinician (MSW)

Quick overview

Requirements summary

Job description

Responsibilities

Website

Benefits

Qualifications

Education

Experience

Licensure

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