Behavioral Health Utilization Review Coordinator

Pembroke Hospital; Pembroke, Northern (MA, KY); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive pay

Generous PTO

Excellent health plans

401(k) with company match

SoFi student loan refinancing

Tuition reimbursement

Tuition discount partnership

Job summary

Pembroke Hospital, a 120-bed acute care inpatient behavioral health facility south of Boston, Pembroke, MA, seeks a full-time Utilization Review Coordinator. The role coordinates patient care, conducts daily clinical reviews and supports appropriate utilization and reimbursement, while working with multi-disciplinary teams.

Responsibilities include securing authorizations from payers, education of care levels, auditing appeals, and contributing to utilization data trends to improve outcomes and

Qualifications

• Experience in Utilization Management with payer/provider groups.
• Behavioral health setting experience preferred.
• Strong understanding of payer criteria and authorization processes.

Responsibilities

• Performs daily clinical reviews to secure authorization for continued treatment across payer types.
• Educates and guides on level of care requirements and payer expectations.
• Completes quality/appeal letters and supports post-claim audits.
• Coordinates with social services, business office, intake, and nursing for timely documentation.
• Contributes to monthly utilization data trends and reporting.
• Facilitates physician reviews with payers as required.
• Performs other duties as assigned.

Skills

Utilization management experience

Behavioral health experience

Education

Massachusetts licensure as RN or LCSW/LICSW/LMHC

Job description

Pembroke Hospital, a 120-bed acute care inpatient behavioral health facility south of Boston, Pembroke, MA, seeks a full-time Utilization Review Coordinator. The role coordinates patient care, conducts daily clinical reviews and supports appropriate utilization and reimbursement, while working with multi-disciplinary teams.

Responsibilities include securing authorizations from payers, education of care levels, auditing appeals, and contributing to utilization data trends to improve outcomes and