Behavioral Health Utilization Review Coordinator

Universal Health Services, Inc.; Pembroke (MA); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Competitive compensation

Paid time off

Medical, Dental, Vision, and Rx plans

401(K) with company match

Student loan refinancing program

Tuition reimbursement program

Education partnership with Chamberlin

Job summary

Universal Health Services, Inc. Pembroke Hospital in Pembroke, MA is seeking a full-time Utilization Review Coordinator to ensure timely authorization for continued treatment across payer types.

The role collaborates with a multidisciplinary team to meet payer criteria and improve patient outcomes. The position requires MA licensure as RN/LCSW/LICSW/LMHC and UM experience, with a preference for behavioral health background.

Qualifications

• Massachusetts licensure as RN, LCSW, LICSW, or LMHC is required.
• Experience in Utilization Management.
• Behavioral health experience is preferred.

Responsibilities

• Performs daily clinical reviews with payer types to secure authorization for continued treatment.
• Educates and guides on level of care requirements and payer expectations for patient acuity and utilization.
• Completes timely appeal/denial letters and supports CMS compliance.
• Coordinates with hospital operations to ensure documentation aligns with patient conditions.
• Contributes to monthly utilization data trends using hospital data tools.

Skills

Utilization Review

Team collaboration

Regulatory knowledge

Job description

Universal Health Services, Inc. Pembroke Hospital in Pembroke, MA is seeking a full-time Utilization Review Coordinator to ensure timely authorization for continued treatment across payer types.

The role collaborates with a multidisciplinary team to meet payer criteria and improve patient outcomes. The position requires MA licensure as RN/LCSW/LICSW/LMHC and UM experience, with a preference for behavioral health background.