Utilization Review Coordinator - Full Time

Pembroke Hospital; Pembroke, Northern (MA, KY); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive pay

Generous PTO

Excellent health plans

401(k) with company match

SoFi student loan refinancing

Tuition reimbursement

Tuition discount partnership

Job summary

Pembroke Hospital, a 120-bed acute care inpatient behavioral health facility south of Boston, Pembroke, MA, seeks a full-time Utilization Review Coordinator. The role coordinates patient care, conducts daily clinical reviews and supports appropriate utilization and reimbursement, while working with multi-disciplinary teams.

Responsibilities include securing authorizations from payers, education of care levels, auditing appeals, and contributing to utilization data trends to improve outcomes and

Qualifications

• Experience in Utilization Management with payer/provider groups.
• Behavioral health setting experience preferred.
• Strong understanding of payer criteria and authorization processes.

Responsibilities

• Performs daily clinical reviews to secure authorization for continued treatment across payer types.
• Educates and guides on level of care requirements and payer expectations.
• Completes quality/appeal letters and supports post-claim audits.
• Coordinates with social services, business office, intake, and nursing for timely documentation.
• Contributes to monthly utilization data trends and reporting.
• Facilitates physician reviews with payers as required.
• Performs other duties as assigned.

Skills

Utilization management experience

Behavioral health experience

Education

Massachusetts licensure as RN or LCSW/LICSW/LMHC

Job description

Utilization Review Coordinator Opportunity -

This is a full time position, working 40 hours per week.

Pembroke Hospital is a 120-bed acute care, inpatient behavioral health facility located south of Boston, in Pembroke, MA. Situated on 26 acres, we offer inpatient and partial hospitalization treatment to teens, adults and older adults, and our services are designed to assess, stabilize, and treat patients by addressing their primary symptoms and problems. At Pembroke Hospital, all positions begin and end with caring for the Patient. By Listening Deeply and Understanding the Story of our Patients, we will Make a Difference in the Lives we Touch.

The Utilization Review Coordinator facilitates a continuum of service while promoting positive outcome and optimal reimbursement, through coordination of patient care, daily clinical reviews, quality documentation, appeals, and reporting.

Benefit Highlights

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• 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!
• Further your education at a low cost through our Tuition Discount partnership with Chamberlin University
• Student Loan Repayment - $200 per month
• Tuition Reimbursement - $5,000 per year

Responsibilities

• Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on payer’s criteria.
• Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
• Completes quality and timely appeal/denial letters. Participates in post claim recovery review and ongoing audit activity, supporting compliance with CMS and other regulators.
• Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
• Contributes to monthly utilization data trends using hospital data tools to report for the overall operation.
• Facilitates physician reviews with payers as required.
• Performs other duties as assigned/required by this position.

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

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Qualifications

Requirements

• Licensure: Current Massachusetts licensure as a RN, LCSW, LICSW, or LMHC
• Experience in Utilization Management either with a provider, insurance or HMO organization.
• Experience in a behavioral health setting is preferred

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.