Utilization Review Coordinator - Part Time, 24 Hours/Week

UHS • Pembroke, MA

4d • Onsite

About The Position

This is a part time position, working 24 hours per week. Working hours are 8am - 4:30pm, 3 weekdays per week. The schedule will require working every Thursday and Friday with the flexibility to select the third weekday in your schedule. Pembroke Hospital is a 120-bed acute care, inpatient behavioral health facility located south of Boston, in Pembroke, MA. Situated on 26 acres, we offer inpatient and partial hospitalization treatment to teens, adults and older adults, and our services are designed to assess, stabilize, and treat patients by addressing their primary symptoms and problems. At Pembroke Hospital, all positions begin and end with caring for the Patient. By Listening Deeply and Understanding the Story of our Patients, we will Make a Difference in the Lives we Touch. The Utilization Review 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.

Requirements

• Licensure: Current Massachusetts licensure as a RN, LCSW, LICSW, or LMHC
• Experience in Utilization Management either with a provider, insurance or HMO organization.

Nice To Haves

• Experience in a behavioral health setting is preferred

Responsibilities

• 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.
• 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.
• Performs other duties as assigned/required by this position.

Benefits

• 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!
• Further your education at a low cost through our Tuition Discount partnership with Chamberlin University
• Student Loan Repayment - $200 per month
• Tuition Reimbursement - $5,000 per year

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level
• Education Level: No Education Listed