Utilization Management Lead: Payer & Compliance

Fuller Hospital; Attleboro, Northern (MA, KY); Hybrid; USD 100,000 - 140,000; Full time

Benefits offered by this job

Student Loan Repayment

Tuition Reimbursement

Career development opportunities

Supervision for Licensure

Excellent health plans

Job summary

Fuller Hospital in South Attleboro, Massachusetts, is seeking a Manager of Utilization Review to lead utilization management, case documentation, and payer relationships in a 109-bed psychiatric facility.

The role directs precertification, concurrent and discharge reviews, ensures regulatory compliance, and coordinates with physicians to align payer expectations with patient acuity. This is a full-time, 40-hour-per-week position, offering growth opportunities and licensure supervision.

Qualifications

• Licensure in Massachusetts as a RN or behavioral health clinician.
• Experience leading utilization management and regulatory compliance.
• Knowledge of insurance procedures, billing, and managed care practices.

Responsibilities

• Oversees all utilization management functions.
• Oversees precertification, concurrent, and discharge reviews.
• Ensures proper documentation and allocation of treatment resources.
• Participates in hospital operations meetings driving financial and clinical results.
• Liaises with physicians to align engagement with payer expectations and discharge planning.

Skills

Leadership

Coaching

Time management

Data analytics

Payer relations

Education

Massachusetts RN licensure

LICSW / LCSW / LMHC license

Job description

Fuller Hospital in South Attleboro, Massachusetts, is seeking a Manager of Utilization Review to lead utilization management, case documentation, and payer relationships in a 109-bed psychiatric facility.

The role directs precertification, concurrent and discharge reviews, ensures regulatory compliance, and coordinates with physicians to align payer expectations with patient acuity. This is a full-time, 40-hour-per-week position, offering growth opportunities and licensure supervision.