Utilization Review Specialist - Per Diem

Westborough Behavioral Healthcare Hospital • Westborough, MA

77d

About The Position

Westborough Behavioral Healthcare Hospital (WBHH) provides psychiatric stabilization and dual diagnosis treatments for Children, Adolescents and Adult populations in both inpatient and outpatient settings. Our goal is to ensure patients and their loved ones feel comfortable and are well informed regarding treatment options. We are conveniently located in Westborough near the intersection of Route 495 and Route 9. The hospital operates 24/7 with multiple shifts available. Westborough Behavioral Healthcare Hospital is looking for a UR Specialist to provide Per Diem coverage.

Requirements

• Associates or Bachelors degree in a Clinical (medical) or health related field is preferred or related experience.
• 2-3 years experience working as a UR Specialist, Medical Billing or health care quality assurance.
• 3 years of experience in psychiatric setting preferred.
• Knowledge of health care service delivery systems, and third party reimbursement; knowledge of managed care environment.
• Ability to apply and interpret admission and continued stay criteria; understanding of admission and discharge function; familiarity with medical terminology, diagnostic terms and treatment modalities; knowledge of medical record keeping.

Responsibilities

• Initiates authorization requests are complete or requests additional data as necessary.
• Performs concurrent reviews for patients to advocate for authorization for services needed.
• Advises treatment team in documentation of medical necessity in the medical record.
• Maintains communication with the Social Services department to facilitate timely discharge planning.
• Enters complete and accurate documentation into the system describing all patient related admitting/registration activities.
• Follows all regulatory policies and procedures, privacy and security standards in accordance with government agencies including HIPAA requirements.
• Submits discharge clinical as required by payers.
• Upholds the Organization's ethics and customer service standards.

What This Job Offers

• Education Level: Associate degree
• Number of Employees: 101-250 employees