Utilization Management Coordinator

Join our team at Cedar Hills as a Utilization Management Coordinator and learn how you can make a lasting difference in your community!

The Utilization Management Coordinator 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

Repsonsibilites Include:

• Performs timely, daily prior authorizations and clinical reviews for Inpatient and Outpatient levels of care 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.
• Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
• Contributes to monthly utilization data trends using hospital data tools to report for the overall operation.
• Facilitates physician reviews with payers as required.

Who We Are:

Cedar Hills Hospital is a 98-bed, freestanding psychiatric hospital and outpatient center specializing in mental health and substance use disorder treatment. Cedar Hills Hospital provides a wide range of services and programs that offer evidence-based treatment proven to have positive outcomes for our patients. Our inpatient and outpatient services offer supportive and compassionate care through specialty programs tailored to meet the needs of our patients.

Our hospital mission is to provide safe, effective, and compassionate mental health and substance abuse treatment to those in need.

What We Offer

• Benefit package including: Medical/dental/vision (multiple plan types available to suit coverage/cost preferences)
• Student loan re-payment program ($437.50/month)
• 401k with 3% employer match
• Above-market Paid Time Off
• Additional paid sick leave time
• Shift differentials and on-call pay incentives
• Employee stock options
• Career development, leadership training, and promotion opportunities
• Relocation assistance
• Tuition reimbursement
• Free counseling services through our EAP for employees and family members

The range displayed on each job posting reflects the base rate of pay and minimum and maximum target for new hire salaries for the position. Within the range, individual pay is determined by factors including job-related skills, experience, and relevant education or training. Your recruiter can share more about the specific salary range during the hiring process.

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 $15.8 billion in 2024. UHS was again recognized as one of the World's Most Admired Companies by Fortune; listed in Forbes ranking of America's Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 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

• Master's prepared healthcare professional (Counseling, Health Administration, Psychology or Social Work) required or RN with direct experience.
• A minimum of 3-5 years of experience working in an acute inpatient psychiatric setting as a treatment team member and/or utilization management, or a minimum of three years utilization management experience within a payer organization.
• Solid understanding of acute inpatient psychiatric hospital and outpatient operations, including both mental health and substance abuse treatment
• 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.

Avoid and Report Recruitment Scams

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

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.