Utilization Review Coordinator - Impact & Compliance

UHS; Pembroke (MA); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Competitive compensation

Generous paid time off

Excellent medical, dental, vision

401(k) with company match

SoFi student loan refinancing

Tuition reimbursement

Career development opportunities

Student loan repayment

Job summary

Pembroke Hospital, part of Universal Health Services, is hiring a Utilization Review Coordinator to support daily clinical reviews and payer negotiations. This role emphasizes collaboration with the treatment team to ensure appropriate utilization and timely documentation across payer types.

The position focuses on authorizations, appeals, and data-driven reporting to optimize patient care and reimbursement. Massachusetts licensure is required, with experience in utilization management preferred.

Qualifications

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

Responsibilities

• Performs timely, daily clinical reviews with all payer types to secure authorization for continued treatment based on payer criteria.
• Functions as a key member of the multidisciplinary treatment team to guide on level of care requirements and payer expectations for patient acuity and utilization.
• Completes quality and timely appeal/denial letters and supports CMS and regulators through audits.
• Collaborates with hospital operations to ensure timely documentation aligned with patient conditions.
• Contributes to monthly utilization data trends and reporting for overall operations.
• Facilitates physician reviews with payers as required.
• Performs other duties as assigned by this position.

Job description

Pembroke Hospital, part of Universal Health Services, is hiring a Utilization Review Coordinator to support daily clinical reviews and payer negotiations. This role emphasizes collaboration with the treatment team to ensure appropriate utilization and timely documentation across payer types.

The position focuses on authorizations, appeals, and data-driven reporting to optimize patient care and reimbursement. Massachusetts licensure is required, with experience in utilization management preferred.