Utilization Review Coordinator

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

Utilization Review Coordinator Opportunity

Fuller Hospital is a 109-bed licensed, private psychiatric facility located in South Attleboro, Massachusetts providing inpatient and outpatient behavioral health services to residents of Massachusetts and Rhode Island. Inpatient units are designed to treat adults with general psychiatric or intellectual disabilities, as well as adolescents with general psychiatric issues. Patients with co-occurring psychiatric and substance abuse disorders can be treated on most units. Fuller Hospital also provides a less intensive Partial Hospitalization Program (PHP) to patients with psychiatric and co-occurring psychiatric and substance abuse disorders.

The Utilization Review Coordinator is responsible for monitoring the effective and efficient use of health care resources by review of patient admission and continued stay appropriateness in all programs of the hospital. They interact with outside agencies, third party payers, and managed care companies in accordance with contractual agreements, acting as a patient advocate and a representative of the hospital. This is a full time, 40 hour per week position.

Responsibilities

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

Benefit Highlights

• Student Loan Repayment - $200 per month
• Tuition Reimbursement - $5,000 per year
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off (26 days per year + roll over)
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• Supervision for Licensure
• More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

Headquartered in King of Prussia, PA, Universal Health Services, Inc. (NYSE: UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services. Since our founding in 1979, UHS has grown steadily into a premier Fortune 500® corporation perennially recognized by multiple esteemed national rating entities. Through its subsidiaries, UHS operates inpatient acute care facilities, inpatient behavioral health facilities, outpatient and other facilities, nationwide virtual behavioral health services, an insurance offering, a physician network and various related services with physical locations in the U.S., Puerto Rico, Ireland and United Kingdom. www.uhs.com.

Requirements

• 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: Must be able to demonstrate knowledge and skills necessary to provide interventions appropriate to the age of the patients with whom they interact; Demonstrate knowledge of the principles of growth and development over the lifespan, possess the ability to assess data reflective of the patient’s status, and interpret the appropriate information needed to identify each patient’s requirements relative to their age specific needs.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.