Utilization Management (UM) Clinician (MFT, MSW, LCSW, RN)

UHS • Full-time • SACRAMENTO, California, United States • 4d ago

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. 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 Management (UM) Clinician facilitates a continuum of service while promoting positive outcome and optimal reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting.

Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on payer’s criteria.
Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators.

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

Qualifications

Education: Prefer bachelor’s degree from an accredited college or university in nursing, or Master’s degree in social work, mental health or a related field.

Experience: A minimum of one (1) year experience with communication with external review organizations or comparable entities or four (4) years direct clinical experience in a psychiatric or mental health setting.

Licensure: RN, LCSW, MFT, or MSW degree.

Additional Requirements: Trained in Handle with Care (HWC) within the first 30 days of employment. Training provided by Heritage Oaks Hospital.

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $14.3 billion in 2023. 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 96,700 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

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.

Avoid and Report Recruitment Scams

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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