Flexible Part-Time Utilization Review Coordinator

Pembroke Hospital; Pembroke (MA); On-site; USD 39,000 - 55,000; Part time

Benefits offered by this job

Competitive compensation & PTO

Medical, dental, vision plans

401(k) with company match

SoFi student loan refinancing program

Tuition reimbursement & discount with

Job summary

Pembroke Hospital is seeking a part-time Utilization Review Coordinator to support daily clinical reviews and authorization processes. The role features a 24-hour work week with hours 8am–4:30pm on three weekdays, plus every Thursday and Friday, in Pembroke, MA.

Join a patient-centered team dedicated to care coordination and optimal reimbursement. Candidates must hold Massachusetts licensure (RN, LCSW, LICSW, or LMHC) and have prior utilization management experience, preferably in behavioral

Qualifications

• Experience in Utilization Management or equivalent
• Behavioral health setting experience preferred
• Active Massachusetts licensure as RN, LCSW, LICSW, or LMHC

Responsibilities

• Performs timely 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 appeals/denials letters and supports post claim recovery review and audits.
• Coordinates with hospital operations to ensure timely documentation aligned with patient conditions.
• Contributes to monthly utilization data trends using hospital data tools.
• Facilitates physician reviews with payers as required.
• Performs other duties as assigned.

Skills

Utilization Management experience

Behavioral health experience

Education

RN licensure (MA)

LCSW/LICSW/LMHC licensure

Job description

Pembroke Hospital is seeking a part-time Utilization Review Coordinator to support daily clinical reviews and authorization processes. The role features a 24-hour work week with hours 8am–4:30pm on three weekdays, plus every Thursday and Friday, in Pembroke, MA.

Join a patient-centered team dedicated to care coordination and optimal reimbursement. Candidates must hold Massachusetts licensure (RN, LCSW, LICSW, or LMHC) and have prior utilization management experience, preferably in behavioral