UM, Case Manager

Havenwyck Hospital is a Joint Commission-accredited and licensed psychiatric hospital in Auburn Hills, Michigan, specializing in comprehensive, compassionate behavioral health services for children, adolescents, and adults. Our dedicated staff focuses on building strength, confidence, and knowledge within each patient to support lifelong self-care.

About the Role

The Utilization Management Case Manager organizes and conducts the managed care process to support the hospital's mission of excellence in care and service. This role involves coordinating with external payers, treatment teams, and internal departments to ensure optimal patient care and resource utilization.

Responsibilities

• Conduct timely admission and continued stay record reviews with external payers, using approved criteria to determine medical necessity and level of care planning.
• Verify active treatment by completing internal audit reviews within approved time frames.
• Assist the treatment team in the discharge planning process when indicated.
• Act as a liaison between the MD/Clinical Treatment Team and external agencies.
• Report authorizations, denials, and documentation concerns, collaborating across departments to minimize denials and facilitate optimal use of hospital resources.
• Provide external insurance and review entities with an accurate presentation of a patient's medical management, length of stay, and care alternatives within the confines of the client's benefits and financial resources.
• Communicate with the Treatment Team (physicians, nursing staff, social workers, etc.) to advocate for the patient's clinical treatment within the client's benefits and financial resources.
• Assist the team in ensuring the completeness and accuracy of medical records using clinical skills and experience.
• Perform other related duties as assigned.

Requirements

• Bachelor's Degree in social work, psychology, counseling, or nursing required; Master's degree in social work, psychology, or counseling preferred.
• Limited or full licensure (e.g., LBSW, RN, LLMSW, LLP, TLLP, LPC, LMFT).
• A minimum of 2 years of post-graduate related experience in psychiatric or substance abuse treatment required.
• Hospital utilization review/utilization management experience preferred.
• Familiarity with managed health care processes, medical terminology, case management, discharge planning, and/or utilization review preferred.

Benefits

• Challenging and rewarding work environment.
• Competitive compensation and 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).

Universal Health Services (UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services, with annual revenues of $15.8 billion in 2024. UHS operates acute care hospitals, behavioral health facilities, outpatient centers, and ambulatory care access points across the U.S., Washington, D.C., Puerto Rico, and the United Kingdom.