UM Case Manager/Appeals Coordinator

UM Case Manager/Appeals Coordinator Auburn Hills, MI Job Details Full-time $60,000 - $69,000 a year 1 day ago Benefits Loan repayment program Health insurance Dental insurance 401(k) Flexible spending account Tuition reimbursement Paid time off Employee assistance program Vision insurance 401(k) matching Opportunities for advancement Life insurance Referral program Qualifications Master's degree in social work Collaborate with healthcare professionals LMFT Appeals Nursing Bachelor's degree in counseling Utilization review Bachelor's degree in social work Psychiatry RN License LMSW Insurance claim appeals processing Bachelor's degree in psychology LPC Master's degree in psychology Mid-level Master's degree Bachelor's degree LBSW Case management Utilization management Counseling Psychology Substance abuse Medical insurance appeals management Discharge planning Working with individuals with mental health conditions Bachelor's degree in nursing Social Work Working with individuals with substance use disorders Care plans Medical terminology 2 years Interdisciplinary behavioral health coordination Documentation review Master's degree in counseling Hospital experience Internal audits Full Job Description

UM CASE MANAGER/APPEALS COORDINATOR HAVENWYCK HOSPITAL

(a UHS facility) 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. For more information, please visit us at www.havenwyckhospital.com

POSITION SUMMARY

The Utilization Management Case Manager/ Appeal Coordinator has responsibility for organizing and conducting the managed care process and managing the appeal 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 to minimize denials/facilitate optimal use of hospital resources. In addition, this position is responsible for identifying cases for appeal, submitting those appeals, and tracking their status.

QUALIFICATIONS

Bachelor Degree in social work, psychology, counseling or nursing required. Master's degree in social work, psychology, or counseling preferred. Valid license in the State of Michigan as a Limited or fully licensed (LBSW, RN, LLMSW, LMSW, LLP, TLLP, LPC, LMFT, etc.) required. A minimum of 2 years of post-graduate related experience in psychiatric or substance abuse treatment required. Hospital utilization review/utilization management experience preferred Experience in appeals process required. Familiarity with managed health care process, medical terminology, experience in case management, discharge planning, and/or utilization review preferred. If you would like to learn more about this position before applying, please contact Havenwyck Hospital at 248-373-9200.

BENEFIT HIGHLIGHTS

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 Career development opportunities within UHS and its 300+ Subsidiaries Free Basic Life Insurance Tuition Reimbursement SoFi Student Loan Refinancing Program Student Loan Repayment Program - for some degrees and criteria What do our current employees value at Havenwyck Hospital and UHS? An environment that puts patient care first. One of the most rewarding aspects of this job is providing excellent care, comfort, and security to the patients and families you treat, at their most vulnerable times. Supportive and responsive leadership. You are never alone, as you are part of a large network of peer co-workers that routinely exchange ideas and review current topics within the industry. 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 with UHS. About Universal Health Services One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (

NYSE:

UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 300 corporation, annual revenues were $15.8 billion in 2024. 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 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 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.

Job Type:

Full-time Pay:

$60,000.00 - $69,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Flexible spending account Health insurance Life insurance Paid time off Referral program Tuition reimbursement Vision insurance Application Question(s): What is your desired annual compensation?

Education:

Bachelor's (Required)

Experience:

Post Graduate Psychiatric or Substance Abuse Treatment:

2 years (Required)

Hospital Utilization Review/Utilization Management:

1 year (Preferred)

License/Certification:

LBSW, RN, LLMSW, LMSW, LLP, TLLP, LPC, or LMFT (Required)

Work Location:

In person