Behavioral Health Utilization Review Specialist

Talentify; South Attleboro (MA); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Student Loan Repayment

Tuition Reimbursement

PTO 26 days + rollover

Medical/Dental/Vision

Job summary

Fuller Hospital in South Attleboro, MA, seeks a full-time Utilization Review Coordinator to monitor effective use of health care resources across inpatient and outpatient behavioral health services. The role interfaces with outside agencies, payers, and managed care companies, serving as a hospital representative and patient advocate.

Requirements include MA licensure (RN/LCSW/LICSW/LMHC) and 1+ year in utilization management, insurance, or HMOs.

Qualifications

• Licensure: Current Massachusetts licensure as a RN, LCSW, LICSW, or LMHC
• Experience: One (1) or more years of experience in utilization management, insurance, and/or HMO organization
• Knowledge: Ability to provide interventions appropriate to the age of the patients and to interpret data for age-specific needs.

Responsibilities

• Thoroughly reviews the patient’s medical record and assesses medical necessity for admissions based on DSM-IV and hospital criteria
• Reviews treatment through hospitalization to ensure appropriateness of care
• Documents criteria and reviews findings per established policy, procedure, and protocols
• Performs other duties as assigned/required by this position

Job description

Fuller Hospital in South Attleboro, MA, seeks a full-time Utilization Review Coordinator to monitor effective use of health care resources across inpatient and outpatient behavioral health services. The role interfaces with outside agencies, payers, and managed care companies, serving as a hospital representative and patient advocate.

Requirements include MA licensure (RN/LCSW/LICSW/LMHC) and 1+ year in utilization management, insurance, or HMOs.