Part-Time Utilization Review Coordinator — Impact & Reimbursement

Universal Hospital Services Inc.; Pembroke (MA); On-site; USD 48,000 - 56,000; Part time

Benefits offered by this job

Competitive compensation

401(k) with company match

Tuition discount program

Student loan repayment

Job summary

Universal Health Services, Pembroke Hospital is seeking a part-time Utilization Review Coordinator to support daily clinical reviews and payer decisions. The role requires Massachusetts licensure (RN/LCSW/LICSW/LMHC) and UM experience, with a preference for behavioral health background.

The position involves coordinating with the multidisciplinary team, ensuring timely documentation, and contributing to utilization data trends. Flexibility to work three weekdays, 8am–4:30pm, is required.

Qualifications

• Licensure to practice in Massachusetts is required.
• Experience in Utilization Management is required or preferred.
• Behavioral health experience is preferred but not required.

Responsibilities

• Performs daily clinical reviews across payer types to obtain authorization for continued treatment based on payer criteria.
• Educates and guides the treatment team on level of care, payer expectations, and patient acuity.
• Completes timely appeal/denial letters and supports post-claim recovery and audits.
• Coordinates with social services, business office, intake, and nursing to align documentation with patient conditions.
• Contributes to monthly utilization data trends using hospital data tools for overall operation.
• Facilitates physician reviews with payers as required.
• Performs other duties as assigned.

Skills

Utilization Management

Interdisciplinary teamwork

Regulatory compliance

Education

Massachusetts licensure (RN/LCSW/LICSW/LMHC)

Job description

Universal Health Services, Pembroke Hospital is seeking a part-time Utilization Review Coordinator to support daily clinical reviews and payer decisions. The role requires Massachusetts licensure (RN/LCSW/LICSW/LMHC) and UM experience, with a preference for behavioral health background.

The position involves coordinating with the multidisciplinary team, ensuring timely documentation, and contributing to utilization data trends. Flexibility to work three weekdays, 8am–4:30pm, is required.