Job Description

Job Description

Responsibilities

Havenwyck Hospital is 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.

Havenwyck Hospital UHS Benefits include:

* 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!
* Tuition Assistance

What do our current employees value at Havenwyck Hospital & UHS?

An environment that puts patient care first. One of the most rewarding aspects of working as an employee is providing excellent care, comfort, and security to the patients and families you treat, at their most vulnerable times. Supportive and responsive leadership. 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 as an employee with UHS.

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, our annual revenues were $10.77 billion in 2018. In 2020, UHS was again recognized as one of the World's Most Admired Companies by Fortune; in 2019, ranked 293 on the Fortune 500; and in 2017, listed 275 in Forbes inaugural ranking of America's Top 500 Public Companies. Headquartered in King of Prussia, PA, UHS has more than 87,000 employees and through its subsidiaries operates 26 acute care hospitals, 327 behavioral health facilities, 40 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.

Havenwyck Hospital is seeking a dynamic and talented Lead Utilization Management Case Manager, to join our team of compassionate and dedicated clinical professionals.

The Lead Utilization Management (UM) Case Manager has responsibility for daily case assignments to the UM staff and the daily monitoring, tracking, and reporting of Medicare Certificates. The Lead UM Case Manager demonstrates understanding of the UM Review Process and acts as a resource for UM staff. The Lead UM Case Manager, under the direction of the Director of UM, develops procedures for UM departmental activities and processes. The Lead UM Case Manager has responsibility for organizing and conducting the managed care 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. Report authorizations, denials, and documentation concerns, as well as collaborate effectively across departments to minimize denials/facilitate optimal use of hospital resources.

Duties include, but are not limited to:

* On a daily basis, manages the assignment of cases to the UM staff and ensures equitable distribution of caseload.
* Monitors, tracks and reports Medicare Certificates and ensures their accurate completion by contacting the appropriate staff or physician.
* Demonstrates higher understanding of the UM Review Process and acts as a resource for UM staff. Under the direction of the Director of UM, develops/documents procedures for UM departmental activities and processes.
* 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.
* 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

Qualifications

* Master's degree in social work, psychology, or counseling; or a Bachelor's degree in nursing required.
* Unrestricted and fully licensed (RN, LMSW, LP, LPC, etc.) required.
* A minimum of 2 years of post-graduate related experience in psychiatric or substance abuse treatment required.
* Experience in settings that include inpatient or partial hospitalization preferred.
* Experience with managed health care process, medical terminology, experience in case management, discharge planning, and/or utilization review preferred.
* Employees must be in good standing (employment/corrective action history, performance evaluations, etc.) to be considered for an internal transfer.

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 subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience with the best possible career 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 feel suspicious of a job posting or job-related email, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449

UHS is a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc. and a wholly-owned subsidiary of Universal Health Services, Inc. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its management company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiaries of Universal Health Services, Inc. To the extent any reference to UHS or UHS facilities on this website including any statements, articles or other publications contained herein relates to our healthcare or management operations it is referring to Universal Health Services' subsidiaries including UHS of Delaware. Further, the terms we, us, our or the company in such context similarly refer to the operations of Universal Health Services' subsidiaries including UHS of Delaware. Any employment referenced in this website is not with Universal Health Services, Inc. but solely with one of its subsidiaries including but not limited to UHS of Delaware, Inc.

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