Panama Job Openings
Emerald Coast Behavioral Hospital
Utilization Review Specialist
Panama City
FULL TIME
October 31, 2024
Responsibilities:
Utilization Review Specialist Opportunity
Emerald Coast Behavioral Hospital provides inpatient treatment services to children, adolescents and adults at our 86-bed facility in Panama City, FL and outpatient services to adolescents and adults at our three outpatient centers located throughout the Florida Panhandle. Additionally, we offer specialized treatment for active duty military members through our Military Resiliency Program, specialized chemical dependency treatment and TMS therapy for chronic depression.
Visit us on-line at: https://emeraldcoastbehavioral.com/
The Utilization Specialist facilitates optimal reimbursement through accurate certification and complete chart documentation. Conducts concurrent admission and continued stay reviews based on utilization review criteria. Refers and consults with the Social Services to promote appropriate continued stay or discharge in the absence of definitive documentation and/or review criteria to support hospital stay.
Job Duties/Responsibilities:
Qualifications: Requirements:
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 skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.
Utilization Review Specialist Opportunity
Emerald Coast Behavioral Hospital provides inpatient treatment services to children, adolescents and adults at our 86-bed facility in Panama City, FL and outpatient services to adolescents and adults at our three outpatient centers located throughout the Florida Panhandle. Additionally, we offer specialized treatment for active duty military members through our Military Resiliency Program, specialized chemical dependency treatment and TMS therapy for chronic depression.
Visit us on-line at: https://emeraldcoastbehavioral.com/
The Utilization Specialist facilitates optimal reimbursement through accurate certification and complete chart documentation. Conducts concurrent admission and continued stay reviews based on utilization review criteria. Refers and consults with the Social Services to promote appropriate continued stay or discharge in the absence of definitive documentation and/or review criteria to support hospital stay.
Job Duties/Responsibilities:
- Facilitate optimal reimbursement through certification process. Conduct concurrent admission and continued stay reviews based on utilization review criteria. Obtain initial certifications for urgent and emergent admissions with zero error rate. Obtain continued stay certification with zero error rate.
- Follow-up of all outstanding cases. Communicate 100% of identified case problems to appropriate level. Assess presence of Severity of Illness/Intensity of Service criteria.
- Participate as active partner with Physician, Nursing, and Social Services in treatment team. Refer consults with Social Services to promote appropriate continued stay or discharge. Refer to and consults with other internal staff as needed to facilitate accurate documentation and assure appropriate, timely discharge
- Communicate 100% of concurrent denial case status to Social Services and attending Physician. Check Physician order on chart for match to billing status. Contact Physician to obtain order for clarification of appropriate patient status.
- Communicate with third party payers by providing clinical information (via e-mail, phone or fax) in accordance with established standards, policies and procedures.
- Enter authorization and days approved data into financial and clinical information systems to facilitate hospital billing.
- Ensure all peer reviews are completed according to insurance specifications.
- Audits Medicare charts according to LCD standards. Ensures Medicare certifications are timely and accurate. Report’s findings to appropriate parties. Makes recommendations for solution.
- Manage all denied days be completing appeal letters with copies of patient chart within 14 days of appeal. Follow-ups on all appeals for resolution. Maintains denial log.
- Works within the organization’s utilization management plan in accordance with the mission and strategic goals of the organization, federal and state law and regulations, and accreditation standards
- Reviews payer contracts and regulatory requirements on an on-going basis
- Conducts concurrent reviews, prepares and presents reports and communicates pertinent information to leadership team when needed.
- 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
- So Fi Student Loan Refinancing Program
- Career development opportunities within UHS and its 300+ Subsidiaries!
- More information is available on our Benefits Guest Website: benefits.uhsguest.com
Qualifications: Requirements:
-
Graduate from an LPN Program, Associates Degree in Nursing or Diploma RN or Master’s Degree in Social Work, Psychology, Counseling or other Human Service field required.
- Active Florida State license as RN or LPN required if RN or LPN
- Two (2) years acute care experience required. Behavioral health experience preferred.
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 skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.
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