Behavioral Health Utilization Review Specialist

Fuller Hospital; North Attleborough (MA); On-site; USD 65,000 - 105,000; Full time

Benefits offered by this job

Student Loan Repayment

Tuition Reimbursement

Competitive Benefits

Job summary

Fuller Hospital in Massachusetts seeks an Utilization Review Coordinator to monitor efficient use of resources by reviewing admissions and stays across behavioral health programs. The role interfaces with payers and providers as a patient advocate in a 40-hour work week.

Responsibilities include evaluating medical necessity, reviewing treatment progression, and documenting outcomes. Requires MA licensure and 1+ year in utilization management, with strong assessment and communication skills for

Qualifications

• Licensure as RN, LCSW, LICSW, or LMHC in Massachusetts is required.
• 1+ year of experience in utilization management, insurance, or HMO environments.
• Demonstrates ability to assess data and tailor interventions to patients'' age-related needs.

Responsibilities

• Review patient medical records to determine admission medical necessity based on criteria.
• Monitor patient treatment to ensure appropriateness of care throughout hospitalization.
• Document criteria and findings per policy and protocol; perform other duties as assigned.

Skills

Utilization management

Clinical assessment

Interdisciplinary communication

Education

Massachusetts licensure (RN/LCSW/LICSW/LMHC)

Job description

Fuller Hospital in Massachusetts seeks an Utilization Review Coordinator to monitor efficient use of resources by reviewing admissions and stays across behavioral health programs. The role interfaces with payers and providers as a patient advocate in a 40-hour work week.

Responsibilities include evaluating medical necessity, reviewing treatment progression, and documenting outcomes. Requires MA licensure and 1+ year in utilization management, with strong assessment and communication skills for